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COPYRIGHT DEPOSIT. 



THE BABY 

A Book for Mothers and Nurses 



By Daniel Rollins Brown, A.B., M.D. 



SECOND PRINTING 
Revised 




WHITCOMB & BARROWS 
BOSTON 1913 






Copyright 1908 
By Whitcomb & Barrows 



Composition and Eiectrotyping by 

THOMAS TODD 

14 Beacon Street, Boston, Mass. 



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©CI,A851973 



CONTENTS 

CHAPTB* 

I. The Period of Infancy 

II. The New-Born Baby 

III. The Elements of Food — Digestion 

IV. Lactation .... 

V. Substitute Food 

VI. Substitute-Feeding — Home Modification of Milk 
The Preparation of the Food — Tables 

VII. Substitute- Feeding continued — Infant Foods — Gen- 
eral Directions — The Wet Nurse — Mixed Feed- 
ing — Weaning . 

VIII. The Second Year . 

IX. The Premature Infant • 

X. Sleep — Clothing — Exercise — Bathing — Teeth- 
ing — General Considerations 

XI. Disease in Infants — Infantile Ailments 

XII . Infantile Ailments continued — Accidents and Emer 
gencies ...... 

XIII. Pregnancy — Convalescence after Child-Birth 

Index •••..•• 



FAGB 

I 

4 
13 
22 

28 

47 

83 

99 
105 

no 

132 

146 
181 

195 



lU 



PREFACE 

MANY of the disorders and some of the 
diseases of infancy are directly due to 
improper management; indeed, apart from in- 
herited disease, or vices of constitution, and the 
natural feebleness of the body, the health, and 
in many cases the life of the infant depend upon 
the care it has. Generally the responsibility 
rests upon the mother, or the nurse, for whose 
guidance this little book is presented. 

Encroachment upon the peculiar province 
of the physician has been studiously avoided. 
Whether generally true or not, it is certainly 
true of medicine that a little knowledge is a 
dangerous thing; except, therefore, for refer- 
ence to some of the common slight ailments, 
and to simple measures of treatment that are 
useful in '^ emergencies," diseases in infancy 
are considered only in their relations to prevent- 
able causes. 

In view of the diminished and diminishing 
birth-rate in American families, and of the in- 
creasing inability of the American mother to 
nurse her baby, the subject of artificial feeding 
is becoming more and more important — of 
vital interest and concern not only to the indi- 
vidual and the family, but to the community. 



VI THE BABY 

But until its difBculties and its risks are gener- 
ally recognized, both the prescription of the food 
and the direction of the feeding are likely to be 
left, as they are now, to the mother and the 
nurse. And infants cannot be fed successfully 
by rule; knowledge of the principles of what 
may be termed rational feeding is absolutely 
essential. Many infants live, of course, in spite 
of improper and imperfect food; and many die, 
or are badly developed, or sickly, because they 
are not fed right. Accordingly the subject 
of Food and Feeding has received very full 
consideration. 

While the author has written largely out of 
his own experience, professional and parental, 
the instruction is believed to be in consonance 
with the teachings of generally accepted author- 
ities, save that in the discussion of the principles 
of substitute-feeding the results of comparatively 
recent investigation, already abundantly con- 
firmed by experience, have been taken into the 
account. 

The portion of Chapter VI that deals with 

the preparation of modified milk is adapted 

from a paper read by the author before the 

Section of Diseases of Children of the American 

Medical Association. 

D. R. BROWN. 

Salem, Mass. 



CHAPTER I 

The Period of Infancy 

THE period of infancy, which extends from 
birth to the completion of the first denti- 
tion, occupies about two and a half years. It is 
a period of extraordinary activity in develop- 
ment and growth; within it the most complex 
of living creatures, the conditions of whose 
existence have been suddenly and completely 
changed by birth, is fitted to a new environment; 
and this necessarily involves profound changes 
both of structure and of function in its organism. 
Some of these changes take place at once; 
others are deferred, or occupy considerable 
lengths of time; indeed, the body does not reach 
its full development before the age of about 
twenty-five years. Among the immediate 
changes, for example, is the establishment of 
respiration and of independent circulation of 
the blood. Before birth the child is nourished 
by the blood conveyed to it through vessels in 
the cord that unites it to the mother; at birth 
this cord is severed, of course, its arteries and 
vein shrivel to become fibrous bands, and wholly 
independent circulation of the blood is at once 



2 THE BABY 

established. At birth, the stomach is merely a 
dilatation of the lower end of the gullet (oesoph- 
agus) . Other abdominal organs, also, are hardly- 
more than rudimentary; the liver, however, is 
very large, occupying nearly one-half the abdom- 
inal cavity. The framework of the body (skele- 
ton) is largely composed of cartilage (gristle), 
which is very gradually converted into bone by 
the deposition of lime salts. 

To meet certain extraordinary demands of 
the system, both the heart-beats (pulse) and the 
respirations are very rapid — the latter number- 
ing from 35 to 40, the former from 125 to 140 
a minute; and what is true of the digestive and 
osseous systems is true of the greater part of the 
body. Infancy is preeminently the period of 
physical change — of development and growth. 

Manifestly, therefore, there are considerable 
differences between the physiology of the infant 
and the physiology of the adult, and right man- 
agement in infancy requires that these differ- 
ences shall be understood and taken into the 
account. That they are not understood, and not 
taken into the account, appear in the shameful 
records of infant disease and infant mortality 
that are written year after year. While some of 
the causes of these deaths must be regarded as 
unavoidable — such, for example, as malforma- 



THE BABY 3 

tions, the naturally feeble powers of resistance, 
the diseases peculiar to infants, or to which they 
are especially liable — a very large, probably 
the greater number proceeds from ignorance or 
carelessness of management, particularly as to 
the food and the feeding. 

It is estimated that in this country, during 
a census period, infants equal in number to one- 
fifteenth of the whole population at the end of 
the period are born to die within two years, and 
that fully one-half these deaths are from pre- 
ventable causes/ It appears that our race- 
suicide is committed after children are born to 
us, also. 

Mortality is highest in earliest infancy, and 
progressively decreases with advance in age; the 
older the infant, or child, the greater the prob- 
ability that it will reach maturity. 

Practically, that is, so far as the care of the 
infant is concerned, the most important deficien- 
cies in development are found in the digestive 
system, by reason of which starch, which forms 
so large a part of the diet of the adult, and 
fat, except milk-fat, can be digested but incom- 
pletely and imperfectly, if at all, during the 
earlier periods of infancy. 

1 Committee of One Hundred, of the American Association for the Advance- 
ment of Science, on National Health. 



CHAPTER II 

The New-Born Baby 

IN the nature of things, the new-born baby 
must be committed to the care of an attend- 
ant, preferably a trained nurse, who should be 
competent to take and w4io should have full 
charge of affairs in the lying-in chamber, under 
the direction of the physician in attendance. 

Other things equal, the nurse, in all cases, is 
most efficient who is most faithful to her instruc- 
tions. A disposition to disregard the directions 
of the physician, or to question them, is a pretty 
sure indication of incompetence. Although the 
mother can have but little share in the care of 
the new-born baby, it is desirable that she should 
know something about it, that, on the one hand, 
the child may not suffer from neglect or igno- 
rance on the part of the nurse, and, on the 
other, that the capable nurse shall not be inter- 
fered with should her methods fail to meet the 
approval of interested relatives and friends. 

The infant should be received from the 
hands of the doctor in a well-warmed woolen 
blanket, in which it should be wrapped snugly. 
As soon as may be, the eyes — which must be 

4 



THE BABY 5 

well shielded from light— and adjacent parts 
should be carefully and thoroughly cleansed and 
the lids bathed in warm water (at a temperature 
of ioo°). This immediate local cleansing is 
designed to remove and prevent the entrance 
of certain foreign material that may be present, 
and which is capable of setting up very serious 
inflammatory disease of the eyes. But a bath 
should not be given at this time, not only because 
prolonged manipulation is exhausting to the 
child, but because the unctuous material that 
covers the body is not soluble in water; there is 
risk from the exposure, also. Instead, the body 
should be anointed with olive oil, or with some 
bland ointment — vaseline serves the purpose 
very well, and even lard will do; an ointment 
softens the unctuous material referred to, which 
may then be wiped off easily. Soft rags of old 
linen, to be afterwards burned, should be pro- 
vided for this purpose. The manipulation 
should be gentle, but as rapid as possible. 

The following mixture makes an excellent 
ointment for the baby's toilet at all periods : 

Boric acid 7 grains 

Solid albolene 2 drachms 

Liquid albolene 2 drachms 

Lanolin (anhydrated) 4 drachms 

Rose water 5 drachms 



6 THE BABY 

The cleansing, which should include the 
nostrils and nose-passages, having been com- 
pleted, the remnant of the cord demands atten- 
tion. A "dry dressing" is the only proper one. 
A small central hole should be cut in a square of 
perfectly clean old linen, and the stump of the 
cord drawn through it. A little baby powder 
may be dusted over the skin between it and the 
linen, which is to be wrapped around the cord. 
Ointment is not necessary. 

In the absence of discharge, or sign of irrita- 
tion, this simple dressing should not be disturbed 
until the cord drops off, as it will in from five 
to ten days, leaving a perfectly healed surface at 
the navel. 

Before the infant is dressed, the skin should 
be anointed wherever its surfaces come in 
contact, or it is exposed to irritation from the 
discharges. 

As soon as the cord has been attended to, 
the abdominal band — made from flannel, "all 
wool," and wide enough to cover the entire 
abdomen — should be put on; next comes the 
shirt; then the "pinning-blanket"; finally the 
diaper. The initial toilet is now complete and 
the infant is tired. Accordingly it should be 
loosely wrapped in a light blanket, put in a 
warm place (if practicable, by the side of the 



THE BABY 7 

mother — bearing in mind her own need for 
rest), and left to go to sleep. 

Except the abdominal band, which should 
give slight support, without, however, exerting 
the least compression, all the clothing should be 
very loose. Especial care must be taken that 
the pinning-blanket is not drawn too tight. 

The infant should be accustomed to light and 
to sound gradually. For the first two or three 
days its only needs, usually, apart from quiet, 
are warmth and sleep, though it may be put to 
the breast, if strong enough, after the mother is 
sufficiently rested; not that food is needed so 
soon, or can be obtained from this source, for 
the breast-milk does not appear ordinarily be- 
fore the third day; but because early slight irri- 
tation of the nipples is helpful to the mother 
from its effect upon the womb. The first secre- 
tion of the breasts after childbirth is a yellow- 
ish, viscid fluid, quite different from milk, called 
"colostrum." It has very little food value, but 
is useful to the baby because of its laxative 
property. 

The first discharges from the bowels are 
dark green in color and of a tarry consistency; 
but after two or three days they should take on 
the bright yellow color that is characteristic of 
the dejection^ of the healthy infant. 



8 THE BABY 

Generally the bowels move and the bladder 
is evacuated within three or four hours after 
birth ; but in the absence of malformations, that 
are easily discoverable, a delay of even two or 
three days in the appearance of these discharges 
need cause no alarm. 

Until true lactation is established, the child 
should not have the breasts oftener than three 
times in each twenty-four hours. Constant at- 
tempts at suckling meanwhile can only do harm ; 
the fact that nature does not provide food imme- 
diately is pretty good evidence that it is not 
needed, and, unless lactation is delayed beyond 
the third day, there need be no fear that the 
infant will suffer in any respect if food is with- 
held until the appearance of the breast-milk. 
But after the second day, or after thirty-six 
hours, if the child is fretful, or does not sleep, 
a few teaspoonfuls of a solution of milk-sugar in 
warm water (a level teaspoonful of milk-sugar 
to four or five tablespoonfuls of water), or of 
fresh cows' milk diluted three or four times with 
warm water and sweetened, may be given at in- 
tervals of six or eight hours until the breasts fill, 
or the bottle feeding is begun. The doses of 
catnip tea, sweet oil, molasses, and what not 
that the unhappy infant is sometimes induced 
to swallow are positively injurious. If food is 



THE BABY 9 

given at this time, an artificial nipple of rags 
dipped in the diluted milk should be given the 
child to suck, as it is much more likely to refuse 
the breast if fed from a spoon in advance. 

Before the baby is put to the breast, the 
nipple should be elongated by manipulation, or 
by suction. Care should be taken that the posi- 
tion of the nursling is convenient and comfort- 
able — the head and shoulders raised — and that 
the distended gland does not interfere with the 
free passage of air in and out of the nostrils. 
After nursing, the infant should be laid on its 
right side, so that the heavy liver will not press 
upon the stomach, and left undisturbed. 

The new-born baby has but little vitality, 
and its powers of resistance to injurious influ- 
ences generally are feeble. It is extremely sensi- 
tive to cold: a sudden chilling of the surface of 
the body, or exposure for any length of time to 
a temperature much below blood heat (98^°), 
may be the cause of serious illness, and serious 
illness at this period is almost always fatal. 
Pending the appearance of the breast-milk, the 
less the child is handled, or disturbed for any 
reason, the better; soiled diapers must be 
changed, of course, and local cleanliness is nec- 
essary to prevent discomfort and chafing; but 
it need not be taken up for these purposes. A 



lO THE BABY 

full sponge bath should not be given until after 
the separation of the remnant of the cord. 

The earliest wardrobe should include at least 
three of the following articles: pinning-blanket, 
shirt, abdominal band, petticoat. There should 
be a liberal supply of diapers ; they may be made 
from old cotton cloth, which is much better for 
the purpose than new. The special "diaper 
cloth" to be had at all the shops is still better. 
Diapers should be a yard and a half wide, and 
folded once. Very thick diapers are not only 
uncomfortable, and when wet burdensome on 
account of their weight and likely to chafe, 
but they may cause deformity of the legs — the 
bones of the infant being very easily bent. 
Rubber diapers, which prevent evaporation, 
should not be used at any time, continuously. 

Shirts should be high in the neck and have 
long sleeves. 

Bands should be about four inches wide and 
long enough to go once and a half around the 
body. The underwear should be "all wool," 
both in winter and in summer; if this material 
irritates the skin, it may be lined with linen. 
Silk is the best substitute for wool. 

At birth there are considerable spaces be- 
tween certain contiguous bones of the cranium, 
so that the skull is quite readily compressible. 



THE BABY II 

Accordingly the head of the new-born baby is 
often misshapen from the pressure to which it is 
subjected in the birth. But these deformities 
always disappear naturally, and they should be 
left wholly to nature. 

In the middle line of the cranium — from 
before backward — there is a large opening 
which marks the junction of the bone of the 
forehead with the two bones — one on each side 
— that form the side walls of the skull; this 
opening is called the "anterior fontanelle." A 
corresponding opening in the same line, at the 
junction of the side bones with the bone that 
forms the rear wall, is called the "posterior 
fontanelle." 

The latter closes within five or six weeks, 
but the anterior fontanelle remains partly open 
until the child is from nine to twelve months 
old; from this time it becomes gradually smaller 
until the nineteenth or twentieth month, when it 
should close completely. An open fontanelle 
after the twentieth month is an early sign of 
Rickets. 

Especial attention is directed to the fact 
that the space in the upper part of the throat 
into which the nasal passages open behind, and 
through which the air must pass from the nose 
to the windpipe and the lungs, is very small. 



12 THE BABY 

^^Adenoids" in this situation, or even swelling 
of the parts from so slight a cause as a "cold 
in the head," may be a very serious matter in 
early infancy. 



CHAPTER III 

The Elements of Food — Digestion 

THE food and the feeding of the infant are 
the most important subjects that we have 
to consider; improper or imperfect food not 
only increases the natural liability to disorders 
and disease, in early infancy particularly, but 
is the direct cause of certain diseases from which 
the well-fed infant is exempt. By far the greater 
number of these cases — of ill-development, mal- 
nutrition, and disease — is found among infants 
who are deprived of their natural food, the 
mother's milk; but as the majority of '' bottle 
babies" live, and some of them thrive — appar- 
ently, at any rate — in spite of unsuitable food, 
the difficulties and dangers of substitute-feeding 
are not generally appreciated, and, in practice, 
the physician is not called upon to direct it so 
long as the infant keeps fairly well. 

Artificial feeding, however, is always un- 
natural and hazardous ; while it may be employed 
successfully in a large proportion of cases, the 
management of the dyspeptic infant often taxes 
the resources of the most accomplished and ex- 
perienced physicians, and no absolute rules can 



14 THE BABY 

be laid down even for the feeding of the normal 
infant in health. But there can be no doubt that 
the number of '^difficult cases," the disorders, 
and the diseases of early infancy would be 
materially lessened if the mother and the nurse, 
upon whom the responsibility usually rests, both 
to prepare and to prescribe the food, were in- 
structed in the principles of what may be termed 
rational feeding. 

Normal breast-milk is the only perfect in- 
fant food; and the healthy mother who nurses 
her baby, provided the milk is normal, both 
conserves her own health and largely increases 
the probability of life and health for the child. 

But the nursling, also, may be imperfectly 
nourished; and the evils of malnutrition are so 
great that no least risk that can be avoided 
should be taken. Even to appreciate the risks, 
one must know something about the elements of 
food, something about digestion, and in what 
respects the digestive organs and powers of the 
infant are comparatively deficient. The right 
conduct of substitute-feeding, without this 
knowledge, is simply out of the question. 

THE ELEMENTS OF FOOD 

Perfect nutrition of the body requires that 
the food shall contain all the food elements, of 



THE BABY 1 5 

which there are four classes : proteins, fat, carbo- 
hydrates, minerals. 

1. The principal proteins are: 
Albumin — of which the white of egg is an 

example. 

Casein — the cheese principle of milk. 

Myoscin — the essential principle of muscle 
(lean meat). 

Gluten — the chief vegetable protein, found 
in wheat particularly, and in most cereals used 
as food. 

2. Fat. 

Fat may be obtained from many sources, but 
is supplied mainly by the fat of meat, in butter 
(milk), and in vegetable oils. 

3. Carbohydrates. 

Practically all the carbohydrates are fur- 
nished by two substances, starch and sugar. 
Starch and most of the sugar employed as a 
food are vegetable products; starch is found in 
potatoes and in most grains — corn, wheat, etc.; 
sugar also is very widely distributed in vege- 
tables and fruits. 

4. Minerals. 

Water is usually included among minerals, 
which are derived from inorganic matter. They 
comprise, also, numerous chemical compounds 
known as '^ salts," of which the chloride of so- 



1 6 THE BABY 

dium (common salt) is an example. Uniting 
with other substances, they form a large number 
of new chemical compounds in the body; but 
their chemistry is so complex that we know very 
little about them, except that they are essential 
to nutrition. 

The three elements — fat, proteins, carbo- 
hydrates — all have their source in the activities 
of living beings, animals, or plants; they may 
be regarded, accordingly, as the vital elements 
of food. Each has its particular use in the 
nutrition of the body, though it may serve other 
purposes also; thus, fat has the especial office to 
keep the body warm, but it also gives it energy 
— power to do its work. Carbohydrates — 
starch and sugar — are sources of energy; but 
they yield heat, too. Both fat and carbohydrates 
changed to fat are stored up in the body to meet 
future demands. Proteins, and proteins only, 
are the tissue-building elements; they provide 
material for the growth and repair of all the 
tissues, as bone, muscle, nerve, etc. 

While fat may do duty for carbohydrate and 
carbohydrate for fat, and proteins for both, 
neither fat nor carbohydrate can take the place 
of proteins as builders of tissue. 

A rational dietary supplies all these food 
elements in suitable proportions, though the pro- 



THE BABY 1 7 

portions that are suitable for the individual de- 
pend upon the circumstances or the conditions 
in each case; upon climate, for example, and the 
work that is done. Accordingly, the Eskimo 
consumes enormous quantities of fat in order to 
meet the extraordinary demands of the body for 
heat, and the working man — the brain worker 
as well as the muscle worker — requires a larger 
relative quantity of proteins to make good the 
loss of material that labor of any kind involves. 
It is, of course, practically impossible to provide 
a diet for the adult that is perfectly adjusted to 
the needs of the individual in each case; and this 
is not necessary. Almost everybody takes more 
food than the system requires — there is an over- 
supply of all the food elements. But in the case 
of the adult, nature is usually able to dispose of 
the redundancy, and with an ill-balanced diet to 
deal with, to supply the deficiency of one ele- 
ment from the excess of another, making pro- 
teins do duty for carbohydrates, for example, 
and carbohydrates fill the office of fat. 

But in infancy development is incomplete — 
the digestive organs are comparatively deficient 
and their powers comparatively feeble; accord- 
ingly, too large a quantity of food, too much or 
too little fat, an excess or a deficiency of proteins 
and sugar, may give rise to disorder and disease. 



1 8 THE BABY 

The infant's food, therefore, must be adjusted 
much more carefully to the actual requirements 
of nutrition. 

DIGESTION 

In order that the food elements may be 
appropriated by the body as nourishment, cer- 
tain chemical changes must be made in them. 
These changes are effected by the action of spe- 
cial fluids — secretions — with which the food 
substances come in contact in their passage 
through the mouth, stomach, and small intes- 
tines. These fluids are known as the digestive 
juices. Together they accomplish the digestion 
of all food substances; that is, they separate 
the nutritious elements therein and fit them for 
absorption. 

In the process of digestion the proteins are 
converted into peptones ; the fat is emulsified — 
minutely divided into separate particles, as it 
is found in milk, which is a perfect emulsion; 
the starch is changed into sugar (glucose). All 
this is accomplished mainly by the action of 
four fluids — the saliva, the gastric juice, the 
pancreatic juice, and the bile. 

The saliva is a mixture of the secretions of 
three large glands — in pairs— and numerous 
small ones that discharge into the mouth. Its 
action is largely mechanical, but it has the power 



THE BABY 1 9 

of changing starch into sugar. It is faintly alka- 
line in reaction. 

The gastric juice is the acid secretion of a 
large number of glands situated in the walls of 
the stomach. Its especial and sole office is the 
digestion of the proteins in the food; fat and 
carbohydrates are not affected by it, and there- 
fore pass through the stomach unchanged. 

The pancreatic juice from the pancreas and 
the bile from the liver flow through a common 
duct that empties into the upper part of the 
small intestine ; together they have the power to 
emulsify fat, to change starch into sugar (glu- 
cose), and, to some extent, to digest proteins. 
The main points to be remembered are: ( i) that 
the gastric juice is acid and digests proteins, and 
proteins only; (2) that the pancreatic juice and 
the bile together digest fat and carbohydrates, 
and proteins that escape digestion in the stomach. 

Solid foods should be masticated thoroughly 
before they are swallowed, in order that the 
protein substances may be finely divided and 
the carbohydrates well mixed with saliva before 
the mass reaches the stomach. In the stomach the 
food is exposed to the action of the acid gastric 
juice, which dissolves the proteins contained in 
it and fits them for absorption. Stomach diges- 
tion occupies from one to four hours, depending 



20 THE BABY 

upon the digestibility of the food. The diges- 
tion of the proteins having been completed, or 
nearly completed, the contents of the stomach 
pass slowly out into the small intestines. 

In the upper portion of the small intestines 
the food is subjected to the action of the pan- 
creatic juice and the bile, which together digest 
the fat and the carbohydrates, also, the proteins 
that have escaped from the stomach undigested. 
By the combined action of these different secre- 
tions, the nutritive elements are converted into 
a milk-like fluid called chyle, which is taken up 
from the intestines by the absorbents — minute 
blood vessels (capillaries) and other little ves- 
sels similar in structure, called lacteals, that are 
situated in the intestinal walls. The chyle that 
is absorbed by the blood vessels is conveyed from 
them directly to the liver, through which it 
passes to undergo certain changes before it is 
added to the circulating blood. That which 
enters the lacteals (this portion of the chyle con- 
tains almost all the fat) is carried by lymphatic 
vessels (which are like the veins in structure and 
in function, except that, in other situations, they 
convey lymph instead of blood) to a small pipe, 
or tube (the thoracic duct), which ascends from 
the abdomen through the chest (thorax), and 
discharges directly into the blood current 
through a vein at the root of the neck. After 



THE BABY 21 

the separation and absorption of the chyle, the 
innutritious residue of the food substances passes 
on into the large intestines, from which it is 
finally expelled as waste material. 

In the stomach the food is kept constantly 
in motion by the action of the muscles of which 
the walls of the stomach are mainly composed, 
which gives it a sort of churning movement; by 
this means the whole mass is thoroughly mixed 
with the gastric juice. Intestinal digestion is 
assisted in the same way by the peristaltic move- 
ments of the intestines. 

In infancy, the gastric juice is comparatively 
weak; and until the child is three or four months 
old, the salivary glands and the pancreas are 
rudimentary (the pancreas is not fully devel- 
oped until near the end of the first year) . Neither 
starch nor fat, therefore — except the fat in cream 
and milk — can be digested in early infancy. 
During the first year, indeed, only the more 
soluble proteins — as the albumins of milk — 
are perfectly digested; the vegetable proteins, 
myoscin, and solid foods generally are practi- 
cally indigestible at this period. 

These deficiencies of the digestive organs, 
and the comparative feebleness of their powers, 
at once suggest the difficulty of providing suit- 
able food for the infant who is deprived of its 
natural aliment — the mother's milk. 



I 



CHAPTER IV 

Lactation 

N normal breast-milk the food elements are 
especially adapted to the peculiar needs of 
the infant, both in quantity and in character. 
But breast-milk is not always normal ; chemical 
analyses show wide differences in its compo- 
sition; its food elements may differ in char- 
acter, also. Apart from variations dependent 
upon the general physical condition of the 
mother, the composition and character of the 
breast-milk are profoundly affected by disorders 
of the nervous system from mental excitement, 
or emotional disturbances; the conditions of 
modern life for a large number of women are 
distinctly unfavorable to the secretion of normal 
milk on this account. 

The popular idea that the quantity of the 
breast-milk may be increased directly by certain 
drugs, or by the use of beer, ale, porter, and the 
like, is not warranted. These agents may be 
useful in some cases to stimulate the appetite, 
or to assist the digestion, but they have no spe- 
cific action. In individual instances, the milk is 
affected by particular articles of food eaten by 

22 



THE BABY 23 

the mother, by certain vegetables, and by cer- 
tain kinds of fish, especially, which in these cases 
should be avoided. 

The nursing mother should have a simple 
but nutritious and varied diet and regular meals. 
During the period of night nursing, particularly, 
a glass of milk, chocolate in some form, or other 
food may be taken with benefit between the 
meals, and if sleep is much interfered with, dur- 
ing the night also. Water should be drunk 
freely. 

Especial care should be taken to obtain 
sufficient sleep, particularly sleep by night, and 
to this end night nursing should be limited to 
the actual necessities of the infant. An evea 
temperament is quite as important as evea 
health. 

Assuming that the mother is able and willing 
to nurse her baby, that the milk is sufficient ia 
quantity and normal in character, successful 
lactation requires, therefore: 

1. A well-balanced diet, with regular mdals. 

2. Regular habits as to exercise and sleep. 

3. Freedom from mental excitement and 
emotional disturbances. 

Unless these requirements are met, the milk 
is likely to be unsuitable, and may be utterly 
unfit for the child. 



24 THE BABY 

When, therefore, the nursling does not thrive, 
suffers from indigestion, or is fretful and out of 
sorts, a chemical analysis of the milk will usu- 
ally reveal the cause of the trouble. In these 
cases the breast-milk may be '' modified'' by 
making suitable changes in matters of diet, exer- 
cise, habits, etc. ; thus, the quantity of fat in 
breast-milk is diminished by disturbances of the 
nervous system, by lack of sufficient sleep, by an 
excess of fat, or a deficiency of proteins in the 
food. 

Proteins are decreased by exercise. Seden- 
tary habits and a generous diet increase all the 
food elements. 

The instruction in Chapter VI as to the 
number of feedings, the intervals between them, 
night feeding, etc., applies equally to the man- 
agement of the nursling. 

Among hindrances to successful lactation are 
depressed nipples, '^sore" nipples, and inflamma- 
tion of the breasts. The nipples may be devel- 
oped — elongated — to some extent by manipula- 
tion — pulling them out from the breast — which 
in some cases may be begun a month or two be- 
fore the birth of the child; but only the gentlest 
handling is permissible, on account of the risk 
of setting up contraction of the muscles of the 
womb, and so causing a miscarriage, and the 



THE BABY 25 

risk of injury to the nipple itself. The nipples 
may be '' toughened" somewhat by bathing them 
with an astringent lotion, such as a weak solution 
of alum in alcohol and water — about five grains 
of alum to an ounce of mixed alcohol and water. 
The use of this lotion should be followed by the 
application of a mild ointment — one part of 
lanolin to three parts of cold cream. An 
astringent alone increases the liability to fissure 
(cracked nipples). 

Very great tenderness of the nipples in the 
beginning is a frequent event. Generally, this 
disappears within a few days, if care is taken to 
keep the parts perfectly clean. Indeed, perfect 
cleanliness is essential at all periods, not only 
as the most effective preventive of local troubles, 
but because the lack of it directly exposes the 
nursling to disorders of digestion and to disease. 
After each nursing, therefore, the nipple should 
be washed with cool water as a routine prac- 
tice. If the tenderness persists, careful examina- 
tion usually discloses a small crack, or fissure, 
or an area of ''raw" surface, which requires 
treatment. Probably the most generally useful 
remedy for these conditions is the compound 
tincture of benzoin, which should be applied 
with a small camel-hair brush after the surface 
has been thoroughly dried with a bit of clean 



26 THE BABY 

linen rag. Several thin "coats" of the benzoin 
should be painted over the fissure, or excoriation, 
as often as need be to keep it well covered. Until 
the parts are thoroughly healed, a nipple shield 
must be employed, which most infants may be 
taught to use, with a little persistence. The 
"Acme" shield is one of the best. Shields with 
rubber tubing attached should not be used unless 
the tubing is renewed daily. If the child is un- 
able to make use of the shield, the milk may be 
drawn with a breast pump and fed from a bottle. 
One or the other of these expedients may be nec- 
essary, also, in cases of depressed nipples. 

The appearance of hard swellings, or lumps, 
in the breast indicates a disorder of the gland, 
which may cause simply an arrest of its activity, 
or give rise to inflammation and ultimately to 
suppuration (abscess). These swellings may be 
painless at first, but are usually sensitive to pres- 
sure. In this condition, prompt treatment will 
often prevent serious trouble; the breast should 
be carefully and thoroughly massaged — the 
movements being made from the circumference 
of the gland towards the center (nipple) always. 
If there is great tenderness, the breast should be 
stroked rather than rubbed, always in the one 
direction, towards the nipple, no force being 
used at first; but generally, as the stroking is 



THE BABY 2/ 

continued, the tenderness becomes gradually less^ 
until at the end of ten minutes, pretty deep pres- 
sure may be made without causing pain. The 
object of this massage is local stimulation, and 
the freeing of the milk ducts, in which the milk 
may become so thickened that they cannot be 
emptied by the usual means. If carefully and 
skillfully employed, this treatment may be ap- 
plied to very ^^sore" breasts, with the happiest 
results in many cases. It should be continued 
at intervals until the lumps and tenderness dis- 
appear, the milk pump being used, also, several 
times a day, if need be. Meanwhile, the affected 
breast may be supported by a bandage, or swathe. 
If, in spite of this treatment, the gland becomes 
hot and painful — inflamed — the physician must 
be consulted without delay. 



CHAPTER V 

Substitute Food 

INFANTS,^ even the normal infant in health, 
cannot be fed successfully by ^' rules." Re- 
quirements differ with individuals and with 
individual conditions. 

Without some knowledge of the principles 
involved and of the facts upon which they are 
based, substitute-feeding cannot be directed 
properly, however clear and full the instructions 
for preparing the food may be, or however care- 
fully they are carried out. To assume the re- 
sponsibility without this essential knowledge is 
to expose the child to grave risks — some of them 
immediate, some remote but not less serious, or 
less certain, because the effects of the misman- 
agement may not appear until long afterwards. 

Since normal breast-milk is a perfect food, 
and the only perfect food for the infant, it fol- 
lows that the food most like it, or that can be 
made most like it, in composition and in the 
character of its food elements, is the best substi- 
tute for it; and this is found, as would naturally 

iln the discussion of substitute-feeding, the term ** infancy" refers to the 
period between birth and the end of the first twelve months. 

28 



THE BABY 



29 



be expected, in the milk of animals. The milk 
of different animals has been used, but none has 
any particular advantage over cows' milk, which 
is cheap and everywhere available. Especial 
study has been given to cows' milk, accordingly^ 
in the endeavor to determine precisely the differ- 
ences between the two fluids, and how to over- 
come them. 

The most important differences disclosed by 
chemical analysis are shown in the following 
table : 



TABLE I 
Chemical Analysis 



Breast-milk. 



( casein .... 
Proteins } 

{ whey-proteins . 

Total proteins 

Fat 

Sugar 

Salts 

Water ..... 



Per cent. 



0.50 
1. 00 
1.50 
4.00 
7.00 
o. 10 

87-88 



Cows' milk. 



f casein . . . 
Proteins < 

( whey-proteins 

Total proteins .... 

Fat 

Sugar 

Salts 

Water 



Per cent. 



2.90 
0.60 

3-50 
4.0a 
4.50 
0.70 
86-87 



It appears from these analyses that both cows' 
milk and breast-milk contain all the elements of 
food; to this extent both are perfect foods. In 
both, these elements are the same in kind, also; 



30 THE BABY 

but, except that the amounts (percentages) of fat 
are equal, their quantities and proportions are 
quite different. If these were the only differ- 
ences, however, it would be a very simple matter 
to make cows' milk equivalent to breast-milk as 
a food for the infant; but, unfortunately, the 
food elements differ in character, also. 

The proteins in both foods consist of casein 
and whey-proteins; but cows' milk contains 
almost six times as much casein as breast-milk, 
and but little more than half as much whey- 
proteins. 

Casein is the cheese principle of milk, the 
substance that forms the curd, or curds, when 
rennet is added, as in the making of cheese. It 
is curdled by acids, also. The clear liquid that 
remains, after the casein has been curdled and 
removed, is whey. Whey contains the whey- 
proteins, which are mainly albumins; like white 
of tgg^ which is pure albumin, they are curdled 
by heat but not by acids. 

The fat of cows' milk differs very much from 
that of breast-milk, both in composition and in 
character, particularly in that it contains a 
very large quantity, comparatively, of fatty 
acids. These acids are irritating, and, in the case 
of the young infant especially, whose fat-digest- 
ing power is feeble, likely to cause digestive dis- 



THE BABY 3 1 

turbances. Moreover, the fat of cows' milk is of 
itself less digestible than that of breast-milk. 

For a long time it was supposed, and medical 
text-books, unless very recently published, teach, 
that the casein of cows' milk is especially diffi- 
cult of digestion for younger infants. In the 
endeavor to change the character of the casein — 
make it more digestible — different means have 
been employed: various chemical agents have 
been added to the milk, the proteins (casein) 
have been predigested, the casein has been re- 
moved altogether, and whey instead of milk used 
in preparing the food. But comparatively re- 
cent investigations have shown that the digestive 
disturbances so long attributed to casein are 
much oftener due to the relatively indigestible 
fat, which, as we have seen, differs very much 
in composition and in character from the fat of 
breast-milk. The lumps of "cheesy" material 
in the stools of infants suffering from indiges- 
tion, commonly taken for ''curds" of casein that 
have passed through the alimentary canal un- 
digested, are found to be masses of fat, or 
clumps of bacteria. 

While these discoveries have undoubtedly 
simplified the problems of artificial feeding, 
cows' milk is by no means equivalent to breast- 
milk as food for the infant, nor is it suitable 



32 THE BABY 

for this use without considerable modification. 
That it may meet the most obvious requirements 
as a substitute food, it is necessary to reduce the 
quantity of proteins and to supply the deficiency 
of sugar. These modifications may be effected 
by dilution and the subsequent addition of fat 
to restore the fat-percentage, and of sugar to 
restore and increase the sugar-percentage. For 
these several purposes, plain water, or cereal 
waters, cream and milk-sugar, respectively, are 
the most suitable materials. In certain condi- 
tions whey may be substituted wholly, or in 
part, for milk, with advantage. Of the different 
chemical agents that have been added to cows' 
milk with view to making it more like breast- 
milk, or more digestible, lime water is the most 
generally efficient; and a small quantity of lime 
in the food is in itself of service. 

These materials, of which all but the dilu- 
ents and lime water are derivatives of milk, meet 
the indications best, and are to be employed 
generally in the preparation of substitute food. 
Each serves, or is intended to serve, a particular 
purpose, and to this end certain conditions 
should be fulfilled; moreover, there are different 
varieties of the milk products (cream, etc.). In 
the first place, therefore, it is necessary to con- 
sider the materials themselves, and they are 
grouped accordingly: 



THE BABY 33 

Cream. 
Milk. 
Whey. 
Milk-sugar. 
Lime water. 

Diluents — plain water, cereal waters (barley 
water, oatmeal water, rice water) . 

CREAM 

Cream contains precisely the same elements 
that are found in milk. It may be regarded, 
indeed, as a very rich, superfatted milk, though 
the elements are in somewhat different pro- 
portions. 

The fat in cream — and milk — is in the form 
of an emulsion; that is, very minute globules^ 
each in an extremely thin envelope of albumin, 
and all "suspended" in the fluid. As we have 
seen, all fat taken as food must be emulsified 
before it can be absorbed; if, therefore, the 
emulsion is broken down and the fat globules 
set free, cream is less digestible. The emulsion 
in cream is destroyed by violent shaking, as when 
cream is churned to make butter; freezing, also, 
breaks it down to some extent. 

There are two kinds of cream: 

1. Gravity cream. 

2. Centrifugal cream. 



34 THE BABY 

Gravity cream is that which rises to the top 
when a quantity of milk is left undisturbed 
("set") for a few hours. 

Centrifugal cream is separated from milk by 
centrifugal force, applied by means of a device 
called a "centrifuge," which removes almost all 
the fat. The violence to which the cream is 
subjected in this operation sets some of the fat 
globules free; that is, destroys the emulsion, 
though only to a slight extent. On this account, 
centrifugal cream is somewhat less digestible 
than gravity cream, but the difference is not 
very great, probably. The emulsion, unless com- 
pletely broken down, is partially restored if 
cream is left undisturbed for a sufficient length 
of time. 

Different varieties of cream, of which there 
are a great number, are named, each according 
to the amount (percentage) of fat that it con- 
tains ; thus, 8 per cent cream contains 8 per cent 
of fat; 1 6 per cent cream contains i6 per cent of 
fat; and so on, up to 6o or 8o per cent cream. 

The fat-value of cream is different at differ- 
ent levels, the upper levels being much richer 
than the lower levels, always ; to take off a few 
tablespoonfuls of cream from the very "top of 
the bottle" of milk that has stood for a few hours 
is to remove a very considerable part of the whole 



THE BABY 35 

quantity of fat. Milk yields, by gravity, a cer- 
tain definite quantity of each variety of cream, 
when the cream is dipped from the top of the 
bottle after it has risen; for example, the top 
four ounces taken together contain 20 per cent 
of fat; the top eight ounces together contain 
12 per cent of fat, etc. The strength of cream 
does not increase materially after it has sepa- 
rated; the thickening on standing is due almost 
entirely to the growth of bacteria, which rise 
with the fat. This explains why cream ''sours" 
sooner than milk under the same conditions. 

As the fat-value of cream increases there is 
corresponding decrease in the quantities of 
proteins and sugar; that is, the richer the cream 
in fat, the poorer it is in the other vital food 
elements. 

MILK 

There are three varieties of milk that may 
be employed in the preparation of substitute 
food: 

1 . "Whole " milk, from which no fat ( cream) 
has been removed. 

2. Skim milk, from which a part, or all the 
gravity cream has been taken. 

3. ''Fat-free" milk, from which the cream 
has been separated by the centrifuge. ("Fat- 



36 THE BABY 

free" milk, however, always contains a small 
quantity of fat.) 

It is of very great importance that the milk 
to be employed as a substitute food should be 
suitable; uniform in character and quality, and 
'* clean." 

The milk of the Jersey and Guernsey cows 
is peculiarly unfit for substitute-feeding : ( i ) be- 
cause it contains exceptionally large amounts 
of the irritant fatty acids; (2) because the emul- 
sion is easily destroyed. Among the breeds of 
cows that give suitable milk are the Ayrshire, 
the Durham, the common red cow, and the 
Holstein, though Holstein milk may be some- 
what deficient in fat; i.e., contain less than the 
4 per cent that is required by law in many, if 
not in most, states of the Union. 

Apart from its suitability, which depends 
upon the breed of the cows, the fitness of milk 
for this, or indeed for any food purpose, de- 
pends upon the care and feeding of the animals 
themselves; upon the dairymen and the dairy 
methods. Abusive treatment, or the fear of it, 
through its effect upon the nervous system of the 
animals, impairs the quality of the milk; even 
its composition — the actual percentages of fat, 
proteins, and sugar — may be changed by a 
beating. 



THE BABY 37 

The chemical changes that take place in milk 
— souring, for example — are due to the action 
of minute (microscopic) vegetable organisms — 
little plants known as bacteria, of which there 
are a great many varieties. Some of them, but 
fortunately only a few, are disease germs ; that is, 
they operate in the body as specific causes of 
disease, or of certain diseases — of which diph- 
theria and tuberculosis (consumption) are ex- 
amples. At ordinary degrees of warmth, as 
between 70° and 100°, bacteria grow very rapidly 
in milk, doubling in number every twenty min- 
utes. Varieties that are harmless of themselves, 
if allowed to increase in numbers beyond certain 
defined limits, make milk unfit for use, and even 
poisonous, through their power to set up the 
chemical changes (fermentations) referred to. 
Sour milk, however, is neither harmful, nor un- 
healthful as food. By taking extraordinary pre- 
cautions, it is possible to produce a small quan- 
tity of milk that is absolutely free from bacteria ; 
but these little organisms are everywhere present 
in the air, and they are found even in the cow's 
udders. It is therefore practically impossible to 
exclude them altogether from milk, and indeed 
quite unnecessary, for the commoner varieties 
do harm only when present in very large 
numbers. 



38 THE BABY 

Milk that is comparatively free from bacteria 
is said to be "clean," and only "clean" milk is 
fit for any food purpose. As all bacteria are 
heavier than air, they settle everywhere that dust 
settles ; an atmosphere filled with dust is always 
filled with bacteria, also. Accordingly, milk can- 
not be clean if the cow stable and the cows are 
not clean, or if the milkers are dirty; if all 
utensils, from milk pails to milk bottles, are not 
thoroughly washed and scalded as often as used. 
And the best milk may be made unfit for use — 
unclean — through ignorance of right methods 
of care and handling. 

Since it is practically impossible to keep the 
common varieties of bacteria out of milk wholly, 
it is necessary to do one of three things that it 
may not be rendered unfit for food purposes 
within a very short time: (i) destroy them; 
(2) suspend their activities; (3) retard their 
growth, that they may not increase in numbers 
beyond a certain limit. (In many parts of the 
country this limit is defined by law.) 

All bacteria — including disease germs of 
course — are destroyed by exposure to a high 
degree of heat — 212°, the temperature of boil- 
ing water, is sufficient — for half an hour. Food 
substances, utensils, anything thus treated is 
"sterilized"; sterilized food substances in steril- 



THE BABY 39 

ized receptacles will keep without chemical 
change, under all conditions of temperature, as 
long as air is excluded from them. 

The activity of bacteria is wholly suspended 
for a time by exposure to a much lower degree 
of heat — 155° — maintained for half an hour. 
Milk thus treated is said to be "pasteurized." 
Pasteurized milk, in clean, well-stopped bottles, 
kept at a temperature not above 50°, undergoes 
no change for three or four days. 

Continued cold — a temperature of 50° or 
lower — retards the growth of bacteria. Clean 
milk, at a temperature not above 50°, will 
remain sweet for two or three days without 
pasteurization. 

It should be remembered, however, that 
neither pasteurization nor cold destroys bac- 
teria; an intense degree of cold, and long-con- 
tinued exposure thereto, only suspends their ac- 
tivity, which, under favorable conditions — ^heat, 
moisture, and a suitable soil — may be renewed. 

But since the presence in milk of a few bac- 
teria of the "harmless" kinds does not injure 
it — indeed, some varieties are useful; and since, 
as we shall see, the value of raw milk as a food 
for continuous and sole use depends upon its 
being fresh, it is sufficient in this case to limit 
their growth, and for this purpose a moderate 



40 THE BABY 

degree of cold is effective. This limitation of 
growth, however, is absolutely essential to clean 
milk. 

All milk, therefore, ought to be cooled to a 
temperature of 50° as soon as may be, but always 
within fifteen minutes after the milking, and it 
should be kept at this temperature — 50° or 
lower — until it is to be used. 

When milk properly cared for "sours" 
within twenty-four hours from delivery, either 
it was not fresh, or it was not clean at that time. 
(The souring of milk commonly attributed to a 
"thunder shower" is explained by the fact that 
the atmospheric conditions — heat and moisture 
— that accompany thunder storms are favorable 
to rapid growth of the bacteria to which the 
souring is due, but this does not take place unless 
the temperature of the milk is above 50°.) 

Milk employed as a substitute food must be 
fresh as well as clean, the fresher the better; for 
this reason, morning's milk and "nearby" milk 
should be preferred always, other things being 
equal. In the case of the adult, the importance 
of fresh food — animal or vegetable — is shown, 
negatively, in the development of scurvy — a 
disease due to imperfect nutrition — among 
sailors whose diet has been limited to salted 
meats and other preserved articles of food — 



THE BABY 41 

canned or tinned vegetables and fruits. The 
same disease — scurvy: — often appears in infants 
v^ho are deprived of fresh milk for any length 
of time. In or of what this essential property, 
freshness, consists we do not know; the fact that 
in milk it is destroyed by heat suggests that, in 
this case, it may depend upon some vital prin- 
ciple, or organism, to which high temperatures 
are fatal. 

Many dairies of the first class furnish special 
*'baby milk"; that is, milk that is fresh, clean, 
uniform in character and quality, and suitable 
for artificial feeding. Usually an increased 
charge is made for '^baby milk"; but it costs 
no more to produce than any ^' clean" milk, and 
should be made available everywhere at the 
same price. A demand for it would doubtless 
create a supply in every community. 

WHEY 

Whey is milk from which the cheese prin- 
ciple — casein — has been removed. This is ac- 
complished by the addition of rennet, or its 
equivalent preparation, by which the casein is 
formed into a curd or curds. The clear liquid 
that remains after the removal of the curds, by 
straining, is whey. Whey may be obtained from 
whole milk, or from skim milk; in any case, it 



42 THE BABY 

must be heated for twenty minutes at a temper- 
ature of from 145° to 150°, in order to destroy 
the activity of the rennet, or other preparation, 
employed to curdle the casein. Unless this pre- 
caution is taken, the cream, or milk, will be 
curdled when combined with it. Care must 
be taken, however, that the temperature is 
not raised much above 150°; at 155° the whey 
would be pasteurized, and at 158° whey-proteins 
are curdled, just as white of egg is curdled by 
heat. 

The fat-percentage of whey depends both 
upon its source and the method of preparation. 
If the curd is not broken up, or disturbed in any 
way before its removal, most of the fat in the 
milk will be separated with it, and the whey 
will contain only a very small quantity (about 
one-third of i per cent — 0.32 per cent) ; by 
breaking up the curd and thoroughly shaking 
curds and whey before separating them, it may 
be made to contain about 2 per cent of fat. 
Whey thus prepared (from whole milk) is 
known as "2 per cent whey." Whey prepared 
from skim milk contains practically no fat, and 
is called, accordingly, "fat-free whey." Each 
variety of whey contains a little less than i per 
cent of proteins (whey-proteins) and nearly 
5 per cent of sugar (milk containing about 0.60 



THE BABY 43 

per cent of whey-proteins and 4.50 per cent of 
sugar). 

In the cases of infants who are unable to 
digest mixtures of cream and milk, the so-called 
"whey-cream" mixtures may be employed with 
advantage. 

For combination with cream, or with cream 
and milk, whey may be prepared most conven- 
iently from skim milk; generally, a sufficient 
quantity of skim milk for the purpose may be 
obtained from a single quart of milk. Direc- 
tions for the preparation of "whey-cream" 
mixtures are given elsewhere. 

MILK-SUGAR 

As the word implies, milk-sugar is derived 
from milk. Only the recrystallized sugar should 
be used; the commercial article has been found 
to contain large numbers of bacteria. Cane- 
sugar may be used instead of milk-sugar, to 
which it is equivalent in nutritive value. But 
cane-sugar is liable to ferment in the stomach, 
and on this account is objectionable in many 
cases, though it appears to agree with some in- 
fants perfectly well. Milk-sugar, however, has 
certain advantages, by reason of its chemistry, 
which make it generally more suitable. 



44 THE BABY 

LIME WATER 

Lime water has been employed as a modify- 
ing agent for many years, mainly for two pur- 
poses: (i) to correct the acidity of cows' milk 
(cows' milk, however, is not always acid, but 
normal breast-milk is always alkaline) ; (2) to 
render the casein of cows' milk more digestible. 
Discussion of the action of this and of other 
chemical agents that are sometimes employed in 
the preparation of artificial food would be man- 
ifestly out of place here; it must be sufficient to 
say that a small quantity of lime in the food 
is believed to be of service in itself as furnishing 
material for the development of the bones from 
cartilage, while the usefulness of lime water as 
an aid to the digestion of milk is attested by 
well-nigh universal experience. 

To insure alkalinity of the food, 5 per cent of 
lime water — i ounce to 20 ounces (154 pints) ; 
or I drachm (a teaspoonful) to each 2j4 ounces 
of food — is sufficient, though two or three times 
as much may be used in certain conditions. 

Lime water is prepared by adding freshly 
slaked lime to pure cold water. An excess of 
lime — that is, more than the water will dissolve 
— must be used; and this excess, which appears 
as a white powder at the bottom of the contain- 
ing vessel, must be maintained that the constant 



THE BABY 45 

loss of Strength from exposure to air may be 
constantly made good. As freshly slaked lime 
is required, lime water should be prepared in 
small quantities — a pint — at a time, as follows: 
Put a small lump (an ounce) of lime in cold 
water sufficient to slake it — convert it into a 
white powder, which settles to the bottom of the 
vessel; then pour off the water, and add a suffi- 
cient amount of the powder to a pint of pure 
cold water; shake thoroughly, and put aside in 
a tightly corked bottle. Water dissolves only a 
very small quantity of lime. 

CEREAL WATERS 

All cereals contain starch; but the quantity 
in these preparations is very small, and would 
add but little to the nutritive value of the food^ 
even if it could be digested by the infant. And 
cereal water is not employed to this end, but be- 
cause a small quantity of starch in the milk 
serves mechanically to prevent in a measure 
the formation of dense curds of casein in the 
stomach, and assists their breaking up. Barley 
water is the most generally useful; in cases of 
constipation, oatmeal water should be substi- 
tuted. The presence of a small amount of starch 
in food assists the action of the gastric juice 
also. Barley and oatmeal water, respectively, 



46 THE BABY 

are prepared by adding two tablespoonfuls of 
washed pearl barley — or of oatmeal, as the case 
may be — to a quart of cold water, which should 
then be boiled down to a pint, strained while hot, 
and at once set aside in a covered dish to cool. 
A little salt should be added. 

Plain water is as often used as the diluent; 
it should be "pure," of course — within the 
meaning of the word for table use. The purity 
of the "spring water" that is furnished in bottles, 
or brought to our houses in carboys, depends 
quite as much upon the care that is taken in the 
handling as upon the witness of the chemist who 
makes the analysis. A pure water at its source 
may be made unfit to drink by filthy habits, or 
by ignorance and carelessness on the part of the 
men employed to bottle and deliver it. Disease 
germs and chemical impurity cannot be detected 
by the eye, or by the taste, or by the smell. Water 
may be "clear as crystal" and conceal typhoid 
fever; it may be discolored, offensive to smell 
and taste, but harmless when taken into the 
stomach. Water from the tap is more likely to 
be safe than either spring water or well water of 
which the quality is unknown. But water from 
any source may be sterilized by boiling it for 
half an hour; and unless it is of known purity, 
this precaution should be taken. 



CHAPTER VI 

Substitute-Feeding — Home Modification of Milk — 
The Preparation of the Food — Tables 

WE have now considered each of the 
materials usually to be employed to 
make cows' milk suitable for artificial feeding. 
When the composition of milk has been changed 
by admixture with any or with all of them, or 
even by simple dilution with water, it may be 
said to have been ^'modified''; though the term, 
"modified milk," is often, perhaps usually, em- 
ployed in a restricted sense to denote the prod- 
ucts of the milk laboratory, or mixtures of 
cream, milk, etc., that more or less closely re- 
semble them. These laboratories, which have 
been established and are in successful operation 
in all our great cities, furnish modified milk con- 
taining definite quantities (percentages) of fat, 
proteins, and sugar on prescription, just as the 
pharmacist fills prescriptions for mixtures of 
drugs. The physician writes down the exact 
percentages of the food elements that in his 
judgment are indicated, the number of daily 
feedings, and the quantity of food to be given 
at each feeding. The prescription is sent to the 

47 



48 THE BABY 

laboratory to be filled accordingly. Laboratory 
milk is delivered in nursing bottles — each con- 
taining a sufficient quantity for a feeding; 
packed in suitable containers for transporta- 
tion, it is sent long distances. This service is 
said to be very satisfactory — and expensive. 
The milk used in the laboratories is supplied by 
dairies that are under the same management; 
it is, therefore, "clean" milk. Accordingly, lab- 
oratory milk, properly cared for, will keep 
perfectly sweet for several days without 
pasteurization. 

But the "modified milk" of the laboratories 
is by no means essential to successful substitute- 
feeding. The modifying agents employed in its 
preparation — milk-sugar, lime water, cereal 
waters — are readily obtainable, as we have seen; 
and if suitable milk is available, as it is in 
many communities, and should be everywhere, 
home modification may be made with quite as 
good results. Indeed, gravity cream and whole 
milk are to be preferred to the centrifugal cream 
and "fat-free" milk that are now employed ex- 
clusively in the milk laboratories; and to this 
extent the home product, prepared according to 
the instructions to be given, is superior to the 
product of the laboratory. 

Manifestly, if the analysis — the fat, protein, 



THE BABY 49 

and sugar values (percentages) — of the mate- 
rials employed is known, mixtures containing 
definite percentages of the nutritive elements 
may be made by combining these materials 
in proper proportions. This is what is meant 
by "percentage modification" and "percentage 
mixtures." 

This accurate knowledge of food values 
enables us to adjust the food to individual needs 
and conditions with the least possible delay 
and the greatest possible precision, while it re- 
duces the risk of under-feeding to a minimum. 
But the use of "fat-free "milk — in itself trouble- 
some — and of a variety of creams, ranging from 
8 per cent to 32 per cent or more, necessarily 
involves so much confusion that accurate modi- 
fication, outside the laboratory, has been very 
generally regarded as impracticable. 

There is, however, no advantage in the use 
of the richer creams, or of a variety of creams. 
And if, instead of "fat-free" milk, whole milk 
is employed as the basis for the preparation of 
the food, only a single variety of cream is neces- 
sary; and a single quart of milk yields enough, 
by gravity, for the preparation of the daily food 
for the infant at all periods, up to the age of 
ten or twelve months, and under all conditions. 

If, for any reason, richer cream (than the 



50 THE BABY 

top 6 ounces) is desired, the top 4 ounces only 
should be taken from the quart of milk; this 
contains 20 per cent of fat. Cream containing 
16 per cent of fat may be obtained by mixing 
3 parts of 20 per cent cream with i part of milk; 
thus 4 ounces of 20 per cent cream, mixed with 
I Yi ounces of milk, is equivalent to ^ys ounces 
of 16 per cent cream. 

Finally, centrifugal cream containing prac- 
tically any desired percentage of fat may be 
ordered from most large dairies of the best class. 
Cream always contains a larger number of bac- 
teria than milk from the same source and under 
the same conditions ; it is the more important, 
therefore, that it should be fresh, clean, and 
properly cared for. 

Milk that contains less than 4 per cent of 
fat is below the standard fixed by law in most 
localities. But "poor" milk — i.e., deficient in 
fat — is not necessarily unfit for substitute-feed- 
ing. The milk of Holstein cows, for instance, 
which is perfectly suitable for the purpose in 
other respects, often contains less than 4 per cent 
of fat. *'Poor" milk does not yield so large a 
quantity of adequate cream, though its quality 
may be quite as good; for example, milk that 
contains 3.50 per cent of fat yields but 5 ounces 
(instead of 6 ounces) of adequate cream. Ac- 



THE BABY 5 1 

cordingly, if the milk in use is "poor," the top 
5 ounces (if very ''poor," the top 4 ounces) 
instead of 6 ounces, should be removed from 
the quart set for cream. If this quantity is in- 
sufficient, an extra pint of milk should be set 
in a suitable vessel — as a pint fruit jar — of 
which the top 2^ ounces (or 2 ounces), after 
8 hours, should be taken and mixed with it. 
Five ounces of gravity cream from a quart of 
^'poor" milk (or 4 ounces from very "poor" 
milk) represents about the same percentage of fat 
as 6 ounces from a quart of standard milk. This 
is explained by the fact that cream grows richer 
as it nears the surface. 

Unless the analysis of the milk is known, 
the fat-value of the cream therefrom cannot be 
estimated so closely, of course; but cream thus 
obtained from ''poor" milk may be used with 
very satisfactory results if standard milk is not 
available. And "poor" milk does not itself con- 
tribute to the food so much fat as standard milk; 
allowance may be made, accordingly, by using a 
little more cream and correspondingly less milk 
in the preparation of the food. The difference 
is so small, however, that it may be disregarded 
usually. 

And there is no advantage, and but very little 
economy, in the use of skim milk, or of "fat- 



52 



THE BABY 



free'' milk, in the preparation of the food — 
since, except for the youngest infants, a suffi- 
cient quantity of fat and proteins for a day's 
feeding cannot be obtained from one quart of 
milk. Two quarts of milk a day, however, will 
furnish both cream and milk enough for the 
infant from the beginning to the end of the usual 
period of substitute-feeding, and will provide 
for the ordinary family, too; that is, the food 
having been prepared, there will be left from 
the two quarts, from about 3^ pints in the be- 
ginning, to about a quart at or near the end of 
the period. Except for the loss of a small por- 
tion of fat (from about i to about i^ per cent), 
this residue is as nutritious as whole milk, and 
quite as useful for most domestic purposes. 

With milk at ten cents a quart, the cost 
of the cream and milk consumed by the infant 
ranges from two cents to twelve cents a day. 
Modified milk, therefore, if prepared at home, 
is at once the best and least expensive substitute 
food. 

EQUIPMENT 



I large pitcher, for mixing the materials 
I small pitcher, for the cream 
I glass graduate, for measuring liquids . 
I sugar measure .... 



Nursing bottles, 3 sizes 



10 small 
8 medium 
6 large 



Capacity 

2 qts. 

(^Pt.) 
8 oz. 

3 oz. 
6 oz. 

10 oz. 



THE BABY 53 

I round-bottomed cream dipper. 

1 glass funnel, for filling bottles. 

I roll of prepared (aseptic) cotton wool, for stopping the nursing bottles. 

I thermometer. 

The ordinary kitchen equipment is usually 
sufficient for pasteurization, etc. 

Liquids are measured most conveniently in 
ounces — called fluid ounces — and in fractions 
of an ounce. 

The values of the common domestic meas- 
ures, which, of course, vary considerably in size, 
are shown in the following table: 

I quart = 32 ounces. • 

I pint= 16 ounces. 

^ pint = 8 ounces. 

I tablespoonful = ^ ounce. 

I teaspoonful (small) = % ounce = i drachm 
(fluid). 

Milk-sugar may be measured in a tablespoon 
— a level tablespoonful contains a little less than 
half an ounce; but a sugar measure is very 
much better for the purpose — one holding half 
an ounce when even full is of convenient size. 
It may be purchased, or improvised by putting 
a sample half ounce of milk-sugar — weighed 
out by the druggist — into a small glass^ and 
marking its upper level by a narrow strip of 
paper, or cloth, pasted on to the outside of the 
glass; divisions into quarter and eighth ounces 



54 THE BABY 

may be indicated in the same way. A small 
pasteboard box may be used instead of a glass. 
Or, the milk-sugar may be purchased in half 
ounce and ounce packages. 

Cotton wool makes the best stoppers for 
nursing bottles, because bacteria cannot get 
through it. Absorbent cotton is equally pro- 
tective, but its absorbent property renders it 
unsuitable for this purpose. 

THE PREPARATION OF THE FOOD 

Two quarts of milk should be provided 
daily from the outset — one for the supply of 
the cream, the other to supply the milk re- 
quired. Practically all the cream that can be 
obtained by gravity from a quart of milk rises 
in 8 hours, and when the milk is "set" in a 
suitable vessel — as a quart milk bottle — is rep- 
resented in the top 6 ounces. This quantity will 
not be required always; but as the fat-value of 
cream is different at different levels, the entire 
6 ounces must always be removed and well 
"mixed" — otherwise the strength of the cream 
employed from day to day will not be uniform, 
and accuracy in making the modifications will 
be impossible. 

The whole quantity of cream obtainable 
cannot be poured from the top of a bottle, 



THE BABY 55 

much less skimmed from milk set in a basin, 
without admixture with milk; a cream dipper, 
therefore, is indispensable. With a round-bot- 
tomed cream dipper the entire 6 ounces may 
be removed, practically free from skim milk. 

Milk should be delivered daily, in bottles 
always, and at such time that it may be cared 
for without delay; exposure for any length of 
time to ordinary atmospheric conditions of heat 
and cold seriously affects its value, for substitute- 
feeding particularly. Even at a temperature of 
60°, bacteria grow rapidly in milk; freezing, on 
the other hand, breaks down the emulsion — and 
the top milk (cream) always freezes first, ren- 
dering the fat less digestible. Moreover, the 
expansion of cream and milk caused by freez- 
ing forces the stoppers from the bottles, ex- 
posing their contents to accidents of various 
kinds. 

As soon as the milk is delivered, therefore, 
one of the quart bottles should be set aside in 
a cold place, on or near ice, or in a mixture of 
ice water and salt, in order to obtain the re- 
quired cream. If the milk is delivered in bulk, 
a quart milk bottle, or a quart fruit jar, should 
be filled, tightly covered, and ^^set" for cream 
under the same conditions. 

From the second quart, after it has been 



56 THE BABY 

poured out into a pitcher — to "mix" it — the 
required quantity (number of ounces) of milk 
should be taken, and also set aside to be kept 
cold until needed. 

At the end of the 8 hours required for the 
cream to rise — earlier, if it had risen partially 
when the milk was set, and preferably within 
the next 2 or 3 hours — the food should be 
prepared as follows: 

1. Remove, with the cream dipper, the top 
6 ounces from the quart of milk set for cream 
(it is usually best to dip out the very top 
cream with a teaspoon) and put it into a small 
pitcher (to "mix" it) ; from this 6 ounces take 
the required quantity of cream and pour it 
into a mixing pitcher. 

2. Add to the cream the milk that has been 
reserved. 

3. Measure out and dissolve the milk-sugar 
in a small quantity of the diluent — water, or 
barley water, etc. — and add it, together with the 
rest of the water, or barley water, to the cream 
and milk. (As the sugar is completely dis- 
solved, it does not increase the total quantity — 
number of ounces — of food.) 

4. The lime water may be mixed with the 
food at this time; or it may be reserved, to be 
added — usually in the proportion of one tea- 



THE BABY 57 

spoonful to each 2j^ ounces of the food — to 
each feeding just before it is given. 

5. Mix these materials together; divide the 
mixture into as many equal portions as the child 
requires feedings in 24 hours — putting each into 
a separate nursing bottle; plug each nursing 
bottle with a wad of cotton wool, and put them 
all aside in a cold place, to be kept until the 
food is required. 

Food for the infant in health may be pre- 
pared in this way, day after day, from week to 
week, through the whole period of substitute- 
feeding, with no variation except that as the 
child develops, the quantities of the materials 
must be changed from time to time to meet 
the changed requirements; this, however, in- 
volves no change in method or manipulation. 

STERILIZATION AND PASTEURIZATION 

Under certain conditions, viz. : if the milk 
in use is old; if it is not clean; if the food 
cannot be kept cold; or if a quantity must be 
prepared from one to several days in advance, 
as, for instance, in provision for a long journey 
— conditions that should be of exceptional 
occurrence only — the food should be either 
sterilized or pasteurized. But sterilization, as 
we have seen, destroys the essential freshness 



^8 THE BABY 

of the milk, in which it produces certain chem- 
ical changes, also. Sterilized milk is less easily 
digested than raw milk, and very generally 
causes constipation. The records show that 
infants who are fed wholly upon it for con- 
siderable lengths of time are especially liable 
to scurvy. 

It is probable that pasteurization impairs 
the nutritive value of milk in the same way, 
or in similar ways, though to less extent and in 
less degree. But pasteurized milk should not 
be employed continuously as a substitute-food. 
Under the conditions named, however, both 
sterilization and pasteurization are of great 
service; and they may be absolutely necessary 
to prevent or to control disorders and diseases 
of the digestive organs. The choice between 
them should be determined by the circum- 
stances, or the particular requirements in each 
case. 

The food is made sterile by exposing it to 
live steam (steam at the temperature of boiling 
water, 212°) for half an hour. If milk con- 
taining considerable amounts of milk-sugar 
and lime water is heated to this degree, a 
caramel is formed which turns it brown. This 
discoloration does not appear to injure the food 
essentially; but it may be avoided by omitting 



THE BABY 59 

lime water in the preparation of the food. In 
this case a sufficient quantity of lime water 
should be added to each feeding just before it 
is given. Except that it is somewhat trouble- 
some, it is better to employ lime water in this 
way always, whether or not the food is 
sterilized or pasteurized. 

The food should be sterilized in the nursing 
bottles, which, preferably, should be boiled or 
baked for half an hour in advance. Arnold's 
Steam Sterilizer is perhaps the most con- 
venient apparatus for the purpose; but other 
sterilizers may be purchased, and an ordinary 
steam cooker, or a deep kettle fitted with a 
tight cover, serves perfectly well. If a kettle 
or "steamer" is used, the bottles containing the 
food should rest upon a perforated support just 
above the level of the boiling water, and the 
steam that is generated should be confined about 
them; and as round-bottomed nursing bottles 
are the only fit ones, they must be supported in 
an upright position in a rack, which may be 
easily improvised from a wire basket. The 
nursing bottles should not be more than three- 
quarters full, and each should be well stopped 
with a plug of cotton wool. 

Ordinarily, the purposes of sterilization are 
served by heating the food for half an hour 



6o THE BABY 

at from 170° to 175°, which destroys all bac- 
teria. Generally, for this purpose, the tempera- 
ture should not be raised above 175°; at 177° 
certain chemical changes take place in milk 
which it is desirable to avoid. But in hot 
weather, or if the food cannot be kept cold 
until it is needed, and in cases of diarrhoeal dis- 
eases, the higher temperature, 212°, should be 
employed. 

The process of sterilization, and of pasteur- 
ization, is a very simple one: Put a sufficient 
quantity of water into a kettle, or ''sterilizer," 
and heat it to the required degree; immerse the 
partially filled nursing bottles to the upper level 
of the milk, and allow them to remain for half 
an hour. During this time, a very nearly uni- 
form degree of heat should be maintained; if 
the food is to be absolutely sterilized, a tem- 
perature of 212° is necessary, i.e., the water 
must be kept boiling; if it is sufficient, as it is 
usually, that the bacteria in the food should be 
destroyed, the temperature should be kept be- 
tween 175° and 170°; if only pasteurization 
of the food is desired, the range of temperature 
should be from 155° to 145°. If milk is heated 
to 158°, the whey-proteins are curdled and made 
less digestible. 

If sterilized milk causes constipation, a 



THE BABY 6 1 

imall quantity — from one-quarter to one-half 
teaspoonful, more or less, according to the age 
and the need — of ^^maltine" may be added to 
each feeding; or ^'maltine with cascara," in 
smaller doses, may be given with every other 
feeding (that is, three or four times in the 24 
hours), either mixed with the food or sepa- 
rately. The latter preparation is slightly bitter, 
and may make the milk objectionable to the 
child's taste if mixed with it. 

Boiled milk, that is, milk boiled in an open 
pot or kettle, has all the disadvantages of steril- 
ized milk, without its advantages; it does not 
^^keep" so long as pasteurized milk usually^ 
and is much less digestible. 

If the milk in use is visibly dirty, and 
therefore necessarily filled with bacteria, it 
should be strained by placing a pledget of 
cotton in the stem of a funnel and pouring 
the milk through it; this will not only remove 
the gross impurities, but large numbers of the 
bacteria, also. But such milk is utterly unfit 
for food purposes, of course, and should not be 
used without sterilization, save from necessity. 

"whey-cream" mixtures 

The so-called "whey-cream" mixtures may 
be very useful in cases of feeble digestive 



62 THE BABY 

powers, as in the feeding of the premature 
infant, or when from any cause the digestion 
of the casein of cows' milk is difficult. They 
are not required for the feeding of the normal 
infant in health; and, generally, are to be 
employed only by and under the immediate 
direction of the physician. 

Whey, as we have seen, contains the whey- 
proteins only — no casein. As these proteins 
are not curdled by rennet or by acids, they 
do not form curds in the stomach, and are 
therefore more digestible than casein. By re- 
placing milk with whey, wholly or partially, 
mixtures containing a sufficient quantity of fat 
with a small percentage of casein and a rela- 
tively large percentage of whey-proteins may 
be obtained. Generally, except for very young 
infants, the highest attainable percentage of 
whey-proteins is indicated in these mixtures; 
this is obtained, of course, by adding the largest 
possible quantity of whey; that is, by using 
whey as a diluent, in place of water or barley 
water, etc. 

The 26 ounces of skim milk that remain 
after 6 ounces of cream have been taken from 
a quart of milk will yield about 20 ounces of 
whey. As the skim milk contains only a small 
amount of fat — from i.oo to about 1.25 per cent 
— whey therefrom is practically free from fat. 



THE BABY 63 

Whey is prepared by adding liquid rennet, 
or Fairchild's Essence of Pepsin, to whole 
milk, or to skim milk, in the proportion of 
two teaspoonfuls of either to each pint of milk. 
The milk must be lukewarm (at a temperature 
of 100°) when the rennet or pepsin is added. 
As soon as the curd is formed, it should be 
separated by straining the mixture through 
cheese cloth. Afterwards, as already noted, 
the whey must be heated to a temperature of 
150° — or between 145° and 150° — to destroy 
the activity of the rennet or pepsin. The 
temperature must be kept closely within these 
limits. 

GENERAL PRINCIPLES 

We have now to inquire as to the principles 
to be derived from the facts that we have 
learned, and their application to the prepara- 
tion and use of substitute-food. 

At birth the stomach holds, without disten- 
tion, about one fluid ounce (two tablespoonfuls), 
and throughout the earlier periods of infancy 
its capacity is small; thus at the age of four 
weeks it is about 2j^ ounces; at two months, 
about 2^2 ounces; at five months, about 5 
ounces. The walls of the stomach are very 
easily stretched, however, so that it may be 



64 THE BABY 

made to contain very much more than its 
normal capacity at different periods. 

In our discussion of the processes of diges- 
tion, the "churning movement" of the stomach, 
which depends upon the alternate contraction 
and relaxation of the different sets of muscles 
of which its walls are mainly composed, was 
referred to; in the case of the bottle baby this 
movement is peculiarly important, if, indeed, 
it is not absolutely essential to the sufficient 
digestion of the casein of cows' milk, which 
differs from that of breast-milk in that it forms 
large, dense curds upon reaching the stomach, 
while the latter forms soft, flocculent, and there- 
fore readily digestible curds. But the tough 
curds of cows' milk are soon broken up by the 
"churning" of which the stomach is capable, 
so that the gastric juice is able to penetrate and 
dissolve them. If, however, the walls of the 
stomach are distended, it is clear that their 
muscular power will be correspondingly dimin- 
ished, and may even be lost altogether. 

It follows that the amount of food, particu- 
larly of substitute food, should be limited to the 
stomach capacity, and that beyond this limit 
deficiency in strength cannot be made up by 
increasing the quantity. In the case of the nurs- 
ling, these muscular movements are not so im- 



THE BABY 65 

portant, as the casein of breast-milk forms very 
soft curds in the stomach; its distention, there- 
fore, does not interfere so much with digestion. 
The small capacity of the stomach furnishes 
one of the reasons why the strength of the 
food in early infancy should be adjusted as 
closely as may be to the actual requirements 
of nutrition. While these requirements are 
different for different individuals — and there 
is always the exceptional case to be provided 
for — they differ for the great majority of in- 
fants within limits that have been pretty well 
defined. We know that food for continuous 
use must contain a sufficient amount of each 
of the food elements. To determine, theoret- 
ically, what this sufficient amount is, it is 
necessary to consider the especial nutritive 
office of each: that fat supplies heat (and 
energy) ; sugar, energy (and heat) ; that pro- 
teins, and proteins alone, furnish material for 
the growth and repair of the tissues. But our 
theoretical mixtures must be subjected to the 
test of experience; for example, while fat is 
essential to nutrition, we have learned by 
experience that mixtures containing only a 
small quantity of fat may be given for a con- 
siderable length of time without materially 
impairing the infant's nutrition. In certain 



66 THE BABY 

conditions infants may be fed on skim milk, 
or fat-free milk, for several weeks, and make 
continuous gain in weight meanwhile; but if 
proteins are withdrawn, or if the quantity is 
decreased below certain limits, even if the 
food contains an excess of fat, nutrition at 
once suffers — the child practically ceases to 
gain in weight, becomes pale and weak, and 
is ravenously hungry. While, therefore, pro- 
teins may be regarded as the most important 
food element, in the sense that they cannot be 
left out, or even reduced in quantity, for any 
length of time, they do not make up for defi- 
ciencies of fat and sugar, unless given very 
largely in excess — far beyond the need of the 
body for building material; and an excess of 
proteins not only disorders digestion, but bur- 
dens unequally the organs of excretion, particu- 
larly the kidneys, by which most of the protein 
waste is removed from the system. We are, 
therefore, brought back to our original propo- 
sition that the food should be well balanced, 
contain enough fat, enough proteins, enough 
sugar, and not more than enough of each of 
these elements. 

While no absolute rules can be laid down 
— even for the feeding of the infant in health — 
careful study and long experience in the use 



THE BABY 67 

of substitute food have established certain aver- 
ages as to the quantities of food required, the 
amounts to be given at each feeding, the per- 
centages of the food elements that are suitable, 
etc. These averages are shown in the tables, 
which for convenience of reference are grouped 
at the end of the chapter. 

USE OF THE TABLES 

The tables are to be used as a guide and as 
a basis for the preparation of additional mix- 
tures. To facilitate their use for these purposes, 
the nutritive value of each of the mixtures tabu- 
lated is stated in terms of percentages. 

Average mixtures, or mixtures suitable for 
the average normal infant in health, are shown 
in Table II. The percentage of fat in each of 
these mixtures may be decreased, or increased, 
without materially affecting the percentages of 
proteins and sugar, by changing the proportions 
of the cream and milk employed. This depends, 
of course, upon the fact that the cream and milk 
contain about the same amoun' both of proteins 
and of sugar. For example : mixture No. IV calls 
for 4 ounces of cream and 5 ounces of milk; if 
we change the proportions of the cream and milk 
by using 3 ounces of cream and 6 ounces of milk, 
the quantity of fat will be reduced from 3.50 



68 THE BABY 

to 3.00 per cent; on the other hand, by using 
5 ounces of cream and 4 ounces of milk, the fat 
will be increased from 3.50 to 4.00 per cent. 
The exchange of 2 ounces of cream and milk 
decreases, or increases, the fat by i.oo per cent. 
In each case, the percentages of proteins and of 
sugar remain substantially the same. 

In the same way, practically any desired per- 
centage of fat may be obtained with each of the 
tabulated percentages of proteins and sugar; for 
example, suppose the infant requires 1.50 per 
cent of proteins, but is unable to digest the usual 
amount of fat. In this case, we select the mix- 
ture that contains the proper percentage of pro- 
teins (No. VI) ; reduce the quantity of cream by 
I or 2 or 3 ounces, as needful, and correspond- 
ingly increase the quantity of milk. 

In mixtures of 24 ounces, each ounce of 
cream and milk exchanged decreases, or in- 
creases, the fat by 0.50 per cent; in mixtures of 
from 30 to 40 ounces, by about 0.35 per cent. 

With the table as a basis, therefore, a great 
number and variety of modifications may be 
made merely by changing the proportions of the 
cream and milk in the tabulated mixtures — 
enough to meet every requirement of the infant 
in health. And as the fat is most frequently re- 
sponsible for disturbances of digestion, the nee- 



THE BABY 69 

( 

essary modification in many cases of indigestion 
may be made in the same simple way. 

We are not to suppose, however, that our 
mixtures, even very carefully prepared, will con- 
tain the exact percentages that are indicated by 
the formulas, though with standard milk in use 
the error should be small, and with milk of uni- 
form quality, tolerably constant; but essential 
accuracy is always attainable. Apart from 
"adapting" the food — individualizing it — the 
"percentages" are important solely on account 
of the relationship between strength and daily 
quantity. Nutrition requires not only, or merely, 
that the food shall have sufficient nutritive value 
— as nutritive value is commonly measured; it 
must contain enough, and, in the case of the 
bottle baby particularly, not more than enough 
of each of the food elements. And to these 
ends, in view of the deficiencies in the infantile 
powers of digestion, of the limited capacity of the 
stomach, in early infancy especially, and of the 
importance of adjusting the food to individual 
needs, percentage modification furnishes at once 
the surest and the safest and the simplest means. 

As foods in general are measured (by calo- 
ries), the mixtures shown in Table II, with the 
exception of the first, have about the same nutri- 
tive value as cows' milk (which is almost pre- 



70 THE BABY 

cisely equal to breast-milk) . In arriving at the 
daily quantity — number of ounces — of food re- 
quired, therefore, cows' milk may be taken as 
the standard of value. 

There is no single perfectly reliable guide to 
the quantity of food required in the twenty-four 
hours, which must be determined finally by the 
sum of the indications in each case; the age is 
one, of course — the most convenient one and, 
therefore, the most generally employed for prac- 
tical purposes, though its value depends mainly 
upon the usual correspondence between age and 
weight. But this correspondence sometimes 
fails. And the infant that weighs 15 pounds at 
four months needs as much food as another of 
the same weight at the age of six or seven months. 
Accordingly, the weight is the best index of the 
requirement in this respect, allowance being 
made for over-weight from too much fat, and 
for under-weight by reason of illness, or imper- 
fect nutrition. 

In early infancy, when normally the gain in 
weight is most rapid, more food comparatively 
is required. Up to the age of five or six months 
a daily allowance equal to about 2 ounces of milk 
for each pound of the body weight should be 
made; above this age, i^ ounces of milk for 
each pound of the weight is sufficient. Larger 



THE BABY 7 1 

daily quantities than these are seldom required, 
and many infants thrive on smaller quantities; 
but a daily allowance less than ij^ ounces of 
milk for each pound of the weight does not pro- 
vide sufficiently for the normal gain in weight, 
usually. Accordingly, for example, an infant at 
two months, weighing lo pounds, should have 
about 20 ounces of food (modified milk), and 
not less than 15 ounces, a day; at seven months, 
weighing 17 pounds, about 29 ounces, and not 
less than 25 ounces a day. But, if the infant 
is making continuous and satisfactory gain in 
weight, and is well, the daily quantity of food, 
however small, should not be increased to meet 
indications of age or weight. (In preparing the 
food, it is best to adhere to the quantities called 
for in the table, which are most suitable as bases 
for the preparation of additional mixtures.) 

The risk of over-feeding is quite as great as 
that of under-feeding, and the consequences may 
be quite as serious. In these cases, either the 
quantity of food or the strength may be at fault. 
Among the evidences of over-feeding are sudden 
abnormal gain in weight (10 or 12 ounces a 
week) , disorders of digestion, and loss of appe- 
tite. The weight soon becomes stationary, or 
declines. The bowels are constipated. The de- 
jections, losing their natural appearance and 



72 THE BABY 

character, become grayish white in color, dry, 
and crumbly, scarcely staining the diapers; or 
they are of the consistency of putty. Itching 
eruptions and eczema are frequent events. In 
some cases, particularly in hot weather, very 
serious illness, attended by symptoms that sug- 
gest cholera infantum, is rapidly developed. 

If over-feeding is recognized early and the 
food at once modified, normal conditions will be 
speedily restored. It may be necessary to reduce 
both the quantity and the strength of the food — 
particularly the percentage of fat; less fre- 
quently, the amount of sugar must be decreased. 
But in cases of chronic over-feeding, evidenced 
by the change in the appearance of the dejec- 
tions, etc., and especially in event of sudden 
acute illness from this cause, milk should be at 
once withdrawn and absolutely withheld for 
at least twenty-four hours; meanwhile, nothing 
but barley water, sweetened with saccharin (one 
grain to the quart) , should be given, though the 
child will not suffer in any respect if only water 
is allowed for this period. Generally, no other 
treatment is required. 

After the age of two or three months, at any 
rate, the necessary modifications may be made 
without reducing the nutritive value of the food 
below that of cows' milk. 



THE BABY 73 

In determining the strength of the food for 
the individual — the quantities (percentages) of 
each of the food elements required — the spe- 
cial nutritive uses of each should be borne 
in mind: that proteins, and proteins only, 
supply material for the growth of the body; 
that fat and sugar furnish heat and energy. 
Accordingly, the rapidly growing infant needs 
more protein than one that grows less rapidly; 
the more active require more food, and, par- 
ticularly, more sugar and more fat than the less 
active, while the sluggish or phlegmatic infant, 
especially if there is a tendency to undue accu- 
mulation of fat, should have less food and, 
particularly, less fat in the food. 

It is clear, as we have remarked, that no 
absolute rules can be laid down, even for the 
feeding of the infant in health. There are, 
however, certain principles by which one may 
and should be guided in adjusting the strength 
of the food to the needs of the individual ; some 
of them have been stated, but for convenience of 
reference they are grouped : 

1. The infant does best upon the mini- 
mum quantity and strength of food necessary 
for nutrition. 

2. Since proteins, and proteins alone, pro- 
vide material for the growth of the tissues, a 



74 THE BABY 

deficiency of protein cannot be supplied by 
giving an excess of fat and sugar. 

3. The use of mixtures containing less than 
i^ (1.50) per cent of proteins — or, in terms of 
cream and milk, less than about 7 ounces 
of cream and milk combined to each pint (16 
ounces) of food — is under-feeding for most 
infants after the age of two or three months. 

4. More than 4 per cent of fat is not 
required for nutrition. 

5. The ratio of fat to proteins in the mix- 
tures ordinarily to be employed in the feeding 
of the normal infant in health, should not ex- 
ceed 3 to I ; that is, with a suitable percentage 
of proteins more than three times as much fat 
is not required; on the other hand, with a suit- 
able percentage of fat the child needs at least 
one-third as much proteins. 

6. The ratio of fat to proteins should 
decrease with the development from 3 to i in 
the beginning to about lys to i at or near the 
end of the usual period of substitute-feeding. 

Only the food that is digested and absorbed 
goes to the nutrition of the body. Undigested 
food in the stomach, or intestines, is very apt 
to cause trouble unless speedily expelled; vomit- 
ing and diarrhcea are often only the efforts of 
nature to get rid of undigested or indigestible 
food. 



THE BABY 75 

The food may be regarded as suitable: 

1. If it is not rejected by the stomach. 

2. In the absence of symptoms of indiges- 
tion — vomiting, colic, diarrhoea, etc. 

3. If the discharges from the bowels are 
natural in appearance and free from lumps, 
^' curds," mucus, etc. (Normally, the evacua- 
tions — from two to four in the twenty-four 
hours — are of the consistency of thick por- 
ridge, perfectly smooth (without lumps), and 
brightly yellow in color, often assuming a 
greenish tinge on exposure to the air.) 

4. If there is continuous and satisfactory 
gain in weight. 

Progressive increase in weight is the most 
reliable index of good nutrition. Up to the 
age of three months the infant should gain 
6 ounces a week — an average of about % 
ounce a day; above this age, about 4 ounces a 
week to the end of the year. An average gain 
of less than ^ ounce a day, in early infancy, usu- 
ally indicates poor nutrition, or illness present, 
or impending. The average weight of the nor- 
mal infant for each month after the third is 
approximately equal to the age in months plus 
ten. 

Failure to make satisfactory gain in weight, 
in the absence of other causes, indicates that the 



76 THE BABY 

food is insufBcient or unsuitable, or that it is 
not digested and absorbed. 

Common symptoms of indigestion are: 
persistent regurgitation — "spitting up" — of the 
food; vomiting; colic; "wind on the stomach"; 
diarrhoea; an unnatural appearance of the dis- 
charges from the bowels, or the presence of 
"curds" (lumps of whitish material) or mucus 
therein. 

Fat-indigestion is indicated by the vomit- 
ing of sour-smelling curds an hour or two after 
a feeding; by diarrhoea, with greenish yellow 
stools, and by the presence of whitish masses, 
or lumps, in the stools; by constipation, with 
large, hard, light-colored (grayish) stools. 

Sugar-indigestion is characterized by"wind" 
on the stomach and bowels; "wind colic," re- 
lieved by the belching of wind and passing it 
by the rectum ; acid discharges from the bowels. 

Protein-indigestion by vomiting of "cheesy" 
material ; bad-smelling stools containing "curds " 
and mucus. The infant fails to gain in weight 
and strength, and is usually hungry. 

Indigestion may be due, also, to an excess 
in the quantity of food given; to over-frequent 
feeding; to some disorder or disease affecting 
the digestive system; and it may be due to 
unsuitable milk, or to milk that has not been 
cared for properly — "unclean" milk. 



THE BABY 'JJ 

The different varieties of indigestion are not 
always sharply defined by the symptoms ; but 
in any case, a change in the composition of the 
food is indicated. Both the fat and the sugar 
may be reduced — and very largely reduced, if 
need be — for a time, without risk of seriously 
impairing nutrition. (Continued deficiency of 
fat, however, exposes the child to rickets.) But 
if the trouble comes from the proteins, the 
reduction may not be carried beyond certain 
limits without grave risks. These limits are 
different for different individuals, and under 
different conditions ; so far as any general state- 
ment can be made, it may be said that in the 
case of young infants- — from one to three months 
old — the percentage of proteins should not be 
carried below 1.25 for any length of time, or 
below 1.50 for older infants. If, after due 
reduction of the proteins has been made, pro- 
tein-indigestion continues; or if the infant^ 
upon the reduced quantity, fails to make satis- 
factory gain in weight and strength, ''whey- 
cream" mixtures maybe substituted for mixtures 
of cream and milk, or the cream and milk may 
be predigested. If ''whey-cream" mixtures are 
employed, the sum of the casein and whey- 
proteins in each case should be equal to the 
percentage of proteins required by the infant 



yS THE BABY 

in health. The "whey-cream" mixtures are 
particularly useful in the management of very 
young infants. 

In difficult protein-digestion, barley water 
should be employed instead of plain water as 
a diluent; the quantity of lime water may be 
increased with advantage, also. 

Predigestion may be accomplished satisfac- 
torily by the use of Fairchild's Peptogenic 
Powder. This powder, with full directions 
for its use, may be obtained at most drug 
stores. 

The cream and milk should be digested 
before lime water is added; otherwise the mix- 
ture will be colored brown. This discoloration, 
however, does not appear to affect the food 
values in the least. Peptogenic powder is 
largely composed of milk-sugar; the amount 
of sugar added to the mixtures should be re- 
duced accordingly. In spite of theoretical 
objections to predigestion, food thus prepared 
may be employed, for considerable periods at 
any rate, without any apparent ill effect. But 
predigestion, which affects only the casein in the 
cream and milk, should seldom be necessary. 

In certain intestinal diseases the fat-digest- 
ing power is very much diminished; in these 
cases, and in some cases of diarrhoea, fat may 



THE BABY 79 

be practically eliminated from the food tempo- 
rarily with the best results; at the same time 
the proteins may often be increased with benefit. 
These indications are met by the use of skim 
milk, or "fat-free" milk, which may or may 
not be diluted with water or barley water. 

In cases of intestinal indigestion, mixtures 
containing a relatively large quantity of proteins 
with a small quantity of fat are indicated; these 
mixtures can be obtained only by the use of skim 
milk, or "fat-free" milk, in the preparation of 
the food. They are seldom required for the in- 
fant in health, and generally should not be 
employed except by the direction of the physi- 
cian. But in appropriate cases they are exceed- 
ingly useful. 

For the preparation of these mixtures, the 
skim milk that is left after the removal of 6 
ounces of cream from a quart bottle of milk 
may be employed usually. This skim milk 
(mixed) contains about 1.25 per cent of fat; 
the lowest 8 ounces contains somewhat less fat 
than this, but even so-called "fat-free" milk, 
obtained by separating the cream with the cen- 
trifuge, contains about 0.50 per cent of fat. 
"Fat-free" milk is supplied by most large 
dairies. In certain conditions, it may be used 
instead of skim milk for preparing the mixtures. 
(Table IV.) 



8o 



THE BABY 






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THE BABY 

TABLE III — '* Whey-Cream " Mixtures 
(In Cases of Weak Protein Digestion) 



8i 



Mixtures, No 


1.* 


II.* 


III.* 


IV. 


V. 


VI. 


VII. 


VIII. 


Materials 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 






Cream 


i 


i 


^ir 


3 


3l 


4i 


Si 


4f 


Milk 


i 


^ 

















If 


Whey (from skim milk) . . 


4t 


8t 


i6^t 


21 


20i 


i9i 


i8f 


i7i 


Milk-sugar 


i 


i 


i 


i 


i 


f 


i 


i 


Water, barley water, etc. . . 


lof 


H 


Si 

















Quantity of food 


i6 


16 


24 


24 


24 


24 


24 


24 




Per 


Per 


Per 


Per 


Per 


Per 


Per 


Per 




cent. 


cent. 


cent. 


cent. 


cent. 


cent. 


cent. 


cent. 


■ fat 


I.OO 


I.OO 


1.50 
0.25 


2.00 


2.50 
0.40 


3.00 
0.50 


3-5° 
0.60 


3.50 

0.75 


^ , casein .... 
Formulas < 


0.25 


0.25 


0-33 


wney-proteins 


0.30 


0.55 


0.75 


0.90 


0.90 


0.90 


0.90 


0.90 


sugar 


3.00 


4.00 


5.00 


6.00 


6.00 


6.50 


7.00 


7.00 



* Nos. I, II, and III are suitable for the premature infant. 

t No. I. By substituting ** 2 per cent whey" the fat is increased from I to 
1.50 per cent. No, II. By substituting '* 2 per cent whey " the fat is increased 
from I to 2 per cent. No. III. By substituting " 2 per cent whey" the fat 
is increased from 1.50 to 3 per cent (nearly). 

Cows' milk in the text refers to the mixed milk 
of a herd of cows. ^^One cow's milk" should 
not be employed continuously as a substitute 
food; fluctuations in the health of the individual 
animal make it much less uniform in character, 
and at times it is utterly unfit for use. 



82 



THE BABY 



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♦^ V 

2-S 



CHAPTER VII 

Substitute-Feeding Continued — Infant Foods — General 
Directions — The Wet Nurse — Mixed Feeding — 

Weaning 

IT remains to consider artificial foods other 
than cows' milk that are very largely used, 
mainly by authority of the manufacturer. 

In our study of foods, we learned that the 
essential proteins can be obtained only from 
animal tissues; from certain families of plants 
— of which two of the most important are rep- 
resented, respectively, by wheat and by beans; 
from eggs and from milk; fat from the fat 
of animals, from vegetable oils and from milk; 
carbohydrates (starch and sugar) from vege- 
tables and fruits, and from milk. 

But the infant cannot eat the flesh of ani- 
mals, while vegetable proteins are quite as un- 
suitable in form, and comparatively hard to 
digest. Moreover, the vegetables that furnish 
proteins are rich in starch also, and young infants 
cannot digest starch. And in our study of diges- 
tion, we learned that fat taken as food must be 
emulsified before it can be absorbed, and that 
this part of the digestive process is accomplished 

83 



84 THE BABY 

by the action of the pancreatic juice; but the 
pancreas is not fully developed, and the pan- 
creatic juice has but little if any emulsifying 
power before the age of ten or twelve months. 

Of all food substances, milk is the only one 
in which the fat is in the form of an emulsion, 
the only one that bears the slightest resemblance 
to the infant's natural food; and cows' milk 
contains precisely the same nutritive elements 
as breast-milk, and is similar in composition. 
There is certainly no reason why we should 
expect to find, among wholly dissimilar prod- 
ucts, a more suitable substitute food, and with 
our present knowledge of the modification of 
cows' milk there is no occasion to seek it among 
them. 

There are, however, many "Infant Foods" 
in the market. Some of them are prepared 
from cows' milk by taking out the water, evap- 
orating it, and in this case we must restore the 
food to its original form, convert it into fluid 
milk of poor quality, by the addition of water. If 
the food is prepared from other materials, fresh 
cows' milk must be added in order to give it the 
necessary food values. Some of these prepara- 
tions are miscalled; that is, they are not foods 
within the meaning of the term as applied to 
them, since their nutritive value depends mainly 



THE BABY 85 

Upon the cows' milk that is added ; and as ^'modi- 
fiers" of milk they have no advantage over other 
and much less expensive agents, while there is 
the disadvantage that their exact composition 
is not known. 

All the patent foods contain a large amount 
of milk-sugar, or its equivalent carbohydrate; 
in many of them, indeed, it is practically the 
only nutritive element. Accordingly, if they 
are employed for purposes of modification, 
milk-sugar (or cane-sugar) should be omitted. 

While each of these foods is composed of 
several different materials in combination, all 
of them, substantially, are included in the three 
general divisions or classes: 

1. Farinaceous Foods. 

2. The "Liebig" Foods. 

3. Milk Foods. 

1. Farinaceous foods are prepared from 
cereals — wheat, oats, barley, etc. They all con- 
tain starch, and are unsuitable for young infants 
on this account. 

2. The "Liebig"' foods, also, are prepared 
from cereals ; but in this case the starch is con- 
verted into a more soluble substance called dex- 
trine; that is, it is practically partially digested. 
Many of them contain malt-sugar (maltose) also. 
Both dextrine and maltose are carbohydrates, 



86 THE BABY 

having the same nutritive ofBce as milk-sugar. 
But as breast-milk contains milk-sugar, it is 
hardly reasonable to suppose that other carbo- 
hydrates serve the purpose better. 

The ^^Liebig" foods are prepared for use by 
the addition of cows' milk. 

3. Milk Foods. 

These foods are prepared from cows' milk 
by evaporating the water, and adding milk- 
sugar or other carbohydrates (maltose, etc.) 
to the residue. The evaporation is effected by 
the application of heat. The milk foods neces- 
sarily lack the essential element of milk — fresh- 
ness; moreover, when prepared for use by the 
addition of water they contain relatively too 
much carbohydrate (sugar, or its equivalent), 
and are deficient both in fat and in proteins. 

The same objections apply to condensed 
milk, or '^evaporated cream," which is pre- 
pared from cows' milk in essentially the same 
way as the dry milk foods; but in this case 
only about 75 per cent of the water of the milk 
is removed (evaporated). The canned article 
contains a very large amount of sugar, which 
is added as a preservative so that the milk will 
keep for some time after the can has been 
opened. 

Condensed milk is sterilized milk, of course; 



THE BABY 87 

and would be unsuitable for continuous use on 
this account alone. 

Infants who have been fed upon canned 
condensed milk may be fat from the very large 
relative quantity of sugar (or maltose, etc.) in 
their food; but the fat baby is not necessarily 
healthy, or well-nourished, and may be very 
poorly nourished. 

That one infant, or two, or ten, lives, even 
if vigorous and apparently well developed, upon 
food that we know is inferior, or improper, or 
imperfect, gives no warrant for the use of such 
food when better may be had and is, indeed, at 
hand. For if the few do well in spite of it, the 
many do very ill because of it. Moreover, 
imperfect nutrition and development are not 
always disclosed at once. 

It should not be understood, however, that 
patent foods are of no value and can be of 
no service; but it should be understood that 
they are much less nutritious than cows' milk, 
to which they are inferior in all respects for 
feeding the normal infant in health. As modi- 
fiers of milk, they add no elements that are 
lacking in cows' milk and are found in breast- 
milk, but they add instead elements that nature 
omitted from both. 

Among those who have given most study 



88 THE BABY 

to the subject, and whose experience in the use 
of artificial food has been largest, there is but 
one opinion: that fresh cows' milk, properly 
modified, is not only the best, but the only fit 
substitute food for continuous use. And all 
scientific records show that infants who are 
deprived of fresh milk for any length of time 
are thereby directly exposed to the evils of mal- 
nutrition, to imperfect development, to disease 
in general, through diminished powers of re- 
sistance, and to certain diseases in particular, 
especially to scurvy and rickets. 

GENERAL DIRECTIONS FOR FEEDING 

These remarks apply to the management of 
the nursling, also. 

Ordinarily, regular feedings should not be 
begun before the third day, when usually the 
mother's breasts "fill." If food is required in 
the meantime, a few teaspoonfuls of a solution 
of milk-sugar (a level teaspoonful of milk-sugar 
to 2 or 3 ounces of water) , or of fresh cows' 
milk diluted with three parts of water, and 
sweetened, may be given three or four times 
in twenty-four hours. The first feedings, how- 
ever, are directed by the physician in attendance, 
generally. If food is given at this time, a rag 
nipple rather than a spoon should be used as 
the means. 



THE BABY 89 

The position of the infant at the breast, or 
when taking food from the bottle, should be 
made convenient and comfortable, with head 
and shoulders slightly raised above the level 
of the rest of the body. In the case of the 
nursling, care should be taken always that 
the distended breast does not shut air from the 
nostrils. 

Artificial food should be lukewarm (at a 
temperature of 100°) when given, since stomach 
digestion cannot go on at a temperature below 
that of the blood. 

The directions given in the tables as to the 
quantity of food to be given at each feeding are 
based upon the average stomach-capacity of the 
infant at different ages. The importance of 
avoiding distention of the stomach, in the case 
of the bottle baby particularly, has been ex- 
plained; unless these quantities are clearly 
insufficient, therefore, they should not be ex- 
ceeded, in early infancy especially. Regurgi- 
tation — the rejection of a portion of the food 
very soon after the feeding — unless caused by 
'^bottle- wind," by the pressure of the liver, 
which in early infancy is very large, or by 
other mechanical cause, usually indicates dis- 
tention of the stomach. The bottle baby almost 
always swallows air with the food, and when 



90 THE BABY 

this "bottle-wind" is expelled, some of the food 
is likely to be expelled with it. This accident 
may be avoided by raising the child to a sitting 
posture immediately after the feeding; in this 
position, the wind usually comes up by itself 
without any loss of food. The "wind" having 
been gotten rid of, the young infant should be 
placed on its right side always, that the weight 
of the liver, which occupies a good part of the 
abdominal cavity on the right side, may not 
press upon the well-filled stomach, either to 
cause regurgitation, or to interfere with the 
muscular movements that so greatly assist 
stomach digestion. Unless due to some of these 
causes, persistent regurgitation means either 
that the food is not suitable or that the diges- 
tion is at fault. (The milk thus rejected is 
necessarily "sour" and "curdled" because the 
gastric juice is acid, and casein always forms 
curds in the stomach.) 

Generally, the nursling will not overload 
the stomach if not allowed to have the breast 
longer than from twenty to twenty-five minutes 
at a time; but in the case of the nursling dis- 
tention does not matter so much, and it is 
always better that the excess of food should 
be rejected. 

As far as may be, the infant should be fed 



THE BABY 9 1 

at regular intervals, which ordinarily should 
not be more frequent than the table prescribes. 

The stomach digestion occupies between one 
and two hours ; when completed, the food passes 
into the intestines; if, before the stomach is 
emptied, a fresh supply of food is added to its 
contents, some of the proteins must escape un- 
digested. Infants fed too frequently often have 
voracious appetites, not because insufficient food 
is taken, but because so much of it, especially 
so much of the proteins, goes to waste. To 
increase the quantity, or the strength, of the 
food in these cases is a serious error. 

Generally, the infant wakes early, and the 
day feedings may be begun at about 6 A.M. 
From this time until about lo P.M. food 
should be given at intervals of not less than two 
and a half to three hours, except for the first 
three or four weeks, when the intervals may be 
shortened to two hours. 

The all too common practice of offering the 
breast, or the bottle, whenever the child frets 
is altogether bad. Fretfulness is very often due 
to slight indigestion, and over-frequent feeding 
only adds to the trouble. 

Habits, good and bad, are easily acquired^ 
even very early in life. Among good habits, none 
is more desirable in infancy than that of sleeping 



92 THE BABY 

at night. To this end, the afternoon nap, which 
should be taken early always, may be denied, 
and even the morning nap shortened, if need 
be, until the right habit has been formed. Night 
feeding, particularly night nursing, should be 
limited to the absolute need for food. The 
quality of the breast-milk is very likely to be 
impaired if the mother fails to get sufficient 
sleep. 

After the last day feeding, at about lo P.M.^ 
infants above the age of two or three months 
should sleep continuously for seven or eight 
hours. If the child wakes in the night, a 
draught of water and change of position — 
perhaps a fresh diaper, also — will usually in- 
duce it to go to sleep again, once the night- 
feeding habit has been broken off. 

The young infant needs water quite as much 
as it needs food, and probably cries oftener 
from thirst than from hunger. A draught of 
water will often quiet the little one when the 
administration of food would be injudicious. 
As early as practicable the water should be 
given directly from a cup rather than from a 
spoon; weaning is less troublesome if the child 
has already been taught to drink from a cup. 

The weight is the only absolutely reliable 
index of the nutrition. In doubtful cases, at 



THE BABY 93 

any rate, it should be tested and recorded daily, 
or every second day, care being taken that the 
conditions as to time of day, clothing, etc., are 
the same always. As already stated, the average 
normal gain is 6 ounces a week for the first 
three months, and about 4 ounces a week 
after that. Loss of weight during the first 
three or four days of life is physiological; 
but this initial loss, which may be as much as 
9 or 10 ounces, should have been made up by 
the end of ten days or two weeks; from this 
time the gain should be continuous. 

Without a record of the weight, it is oftea 
impossible to determine whether or not the 
child is properly nourished. This applies to 
the nursling, also. 

If more food is prepared than the child 
takes in the twenty-four hours, the excess must 
be thrown away, of course; this, however, should 
seldom be more than a few ounces, and as modi- 
fied milk is always diluted milk, the actual waste 
is small. 

The nursing bottle that may be thoroughly 
cleansed most certainly and most easily is the 
best, and that is a bottle with sloping shoulders 
and round bottom. It is well to have as many 
nursing bottles as the child requires feedings 
in the twenty-four hours. The greatest care 



94 THE BABY 

must be taken to keep them perfectly clean. 
After thorough washing with the aid of a 
bottle washer, they should be rinsed in boiling 
water, or in very hot water. Cases of lead 
poisoning have been recorded from the use of 
shot to remove the dried milk from the inside 
of the bottles. Milk left in the bottle after a 
feeding should be thrown away. 

Nipples should be made of pure rubber 
and frequently renewed. Only those that slip 
over the neck of the bottle should be employed. 
They should have several small openings dis- 
tributed around the circumference rather than a 
single larger central one, which is apt to cause 
choking. 

Nipples to which a rubber tube is attached 
for conveying the milk from the bottle ought 
never to be used; it is impossible to keep the 
tube clean. Immediately after a feeding, the 
nipple must be removed from the bottle, turned 
inside out, and thoroughly washed. A little salt 
will assist the cleansing of the rubber when it 
becomes '^coated." When not in use, it should 
be kept alternately in salt and water and in a 
solution of cooking soda, a teaspoonful to a cup 
of water. Not more than twenty-five minutes 
:should be allowed for a feeding; at the end of 
that time, or as soon as the child has finished 



THE BABY 95 

its meal, the bottle should be taken away, at 
once rinsed, and kept filled with water until it 
can be washed thoroughly with soap and brush. 

THE WET NURSE 

With the advance in knowledge of infant 
feeding, the wet nurse has fallen into disfavor. 
Exceptionally, the services of a wet nurse may 
be of the greatest value, but they should be em- 
ployed only on the advice of a competent physi- 
cian. The family or friends are not competent 
judges. A wet nurse must be suitable to the par- 
ticular infant in need of her services, and this 
suitability can be determined only after thorough 
examination by a physician. 

MIXED FEEDING 

When the breast-milk is merely insufficient 
in quantity, being normal in other respects, lac- 
tation should be maintained, and the deficiency 
made up by artificial food. Better results follow 
this so-called mixed feeding, as a rule, than are 
obtained by artificial feeding alone. And the 
younger the infant the greater the risk of de- 
priving it altogether of its natural food, of 
which even a very scanty supply may be of the 
greatest service. The later the use of other 
food is begun the better, since the ability to 



96 THE BABY 

digest and assimilate it increases with age and 
development. If practicable, the breast-milk 
should be analyzed as a guide to the mixtures 
to be employed for the supplementary feeding; 
if the mother's milk is suitable, a modified milk 
containing the same percentages of fat, proteins, 
and sugar may be prepared; if unsuitable in any 
respect, the particular fault may be corrected 
in the preparation of the artificial food. 

WEANING 

Efforts to wean the child, whether from the 
breast or the bottle, should not be made ordi- 
narily until it has reached the age of ten months ; 
or, in the former case particularly, delayed be- 
yond the end of a year, for the reason that the 
mother's milk, even if abundant, is likely to be 
changed in character by prolonged lactation, 
and is often unfit for the infant. 

In general, it may be said that the appear- 
ance of all the incisor teeth — four in each jaw 
— indicates that the digestive organs are so far 
developed that the use of other foods, in addi- 
tion to milk, are permissible; and, it may be, 
desirable. The infant is now able to digest 
starch, and a small quantity of food containing 
starch may be given, often with advantage. 
Barley and oat jellies are suitable preparations 



THE BABY 97 

of the cereals. Milk, however, should be the 
main dependence; indeed, the use of other 
foods is not necessary before the end of the 
year, and by that time the infant should have 
been weaned, ordinarily. But weaning should 
not be attempted when the child is not well; 
or when teeth are coming through ; or in very 
hot weather, and it should be made gradually. 
"Gradually" does not mean that weeks should 
be occupied in making the exchange of the 
breast, or the bottle, for the cup and spoon; 
and once undertaken, the effort should not be 
abandoned, or suspended, without sufficient 
cause. 

The following plan is a very good one: 
assuming that the child has been taught to 
drink from a cup, one of the regular feedings 
is given therefrom for a day or two; then two, 
and so on until the breast, or the bottle, has 
been withdrawn, except for the last feeding at 
ten o'clock. The first time this sole remaining 
solace of the nipple is denied, the substitute will 
be declined vigorously, and the child will cry 
itself to sleep — and must be allowed to do so. 
Generally, no compromise can be effected the 
second night; but the refusal will be less vocif- 
erous and sleep will come sooner. Meanwhile, 
the cup has been gaining in favor. By the third 



98 THE BABY 

night it will have occurred to the little philoso- 
pher that milk from a cup at any time may be 
very much better than none, and a full stomach, 
however filled, more comfortable than an empty 
one "to go to sleep on" ; the experiment will be 
consented to and the ordeal will be over. 



CHAPTER VIII 

The Second Year 

THERE need be no apprehension that the 
child will suffer in any respect if it has 
nothing but milk until well into the second year, 
though the limited use of other foods may be 
begun at the age of ten months. Only the sim- 
plest food substances should be added at first, 
change to the diet of the adult being made very 
slowly. The beginning is to be made usually 
by the use of some of the farinaceous foods in 
combination with milk. Among eligible prepa- 
rations are barley and oat jelly and a pap made 
of stale bread crumbs (boiled in water enough 
to cover them and added to the milk). An 
excellent food for infants with weak digestion 
may be prepared by boiling wheat flour tied up 
in a linen bag for several days, or until it has 
been converted into a chalk-like mass, from 
which a sufficient quantity may be grated and 
mixed with the milk. 

Barley and oat jelly are made as follows: 
Soak 4 ounces of granulated barley, or of coarse 
oatmeal, in a quart of cold water for twelve 
hours ; boil down to a pint, and while hot strain 

99 



lOO THE BABY 

through a fine cloth. On cooling, a jelly is formed, 
of which any desired quantity, salted to taste, may 
be added to the milk. Equal parts of cereal 
jelly and milk may be employed in the begin- 
ning. The oat jelly contains more starch than 
the barley jelly, and a considerable percentage 
of fat also; it is one of the most nutritious of 
the cereals. Until the infant is a year old the 
diet should be restricted to milk, with the addi- 
tion of the simple foods that have been men- 
tioned. But with the beginning of the second 
year the dietary may be enlarged somewhat, 
though milk should be the main dependence 
throughout the period of infancy. 

It may be remarked again that since teething 
is a physiological process, it is never the direct 
cause of illness or disease. The disorders so 
often attributed to the eruption of the teeth are 
always dependent upon other causes, and must 
be regarded accordingly. 

During the second year, as during the first, 
the same food elements — proteins, fat, carbo- 
hydrates, and minerals — of course, must be 
furnished in due proportions. For the supply 
of proteins, milk, the white of egg^ chicken and 
mutton broths, and wheat flour (which contains 
the vegetable protein, gluten) must be relied 
upon mainly. The nutritive principles of 



THE BABY lOI 

meats are not soluble either in hot or in cold 
water; beef tea, therefore, and broths from 
which the fat has been removed, as it should 
be always for the use of the infant, contain little 
or no nourishment, but only the principles that 
give to each kind of meat its peculiar flavor; 
they are of little value save as vehicles for other 
food substances (bread, rice, etc.), and for their 
stimulating effect upon the digestive organs. 

But the child is now able to digest starch, 
and the cereals become an important part of the 
dietary: stale bread, at least a day old; baked 
white potatoes, which may be mixed with milk; 
boiled rice, and the wheat foods generally. Rice 
cones, made by boiling half a cup of rice in a 
pint of milk until all the milk has been absorbed, 
salted, and put aside in small cups to cool, may 
be served with simple custard, at the age of 
sixteen or eighteen months. 

At this age, butter may be added to the bill 
of fare — the cereals being served with butter 
and sugar as well as in milk. Ripe fruits, ex- 
cept bananas, which are comparativel}^^ indigest- 
ible, are permissible during the second year; 
though most of them are better cooked. Sliced 
apples, currants, plums, apricots or other fruit, 
put into a jar, well sprinkled with sugar and 
thoroughly baked, are suitable fruit prepara- 



I02 THE BABY 

tions. Baked apples with milk, or cream, and 
stewed prunes are eligible also — both are par- 
ticularly useful in cases of constipation. 

In the beginning of the second year, five 
meals a day are required ordinarily, of which 
the last should be given late in the afternoon. 
Milk must still be the main reliance, though 
other simple foods may be added, as in the 
following illustrative menu: 

Meal No. i. Bread and milk, warmed. 

No. 2. Oat jelly and milk, equal parts, 
salted. 

No. 3. Mutton or chicken broth, with bread 
crumbs. (All fat should be removed.) 

Nos. 4 and 5. Bread, or oat jelly, and milk. 

Throughout the period of infancy the fol- 
lowing articles should be forbidden: cake of 
all kinds, pastry and candy; all fried foods; 
condiments, except salt; pickles, preserves, etc., 
and vegetables, except potatoes. Generally, 
solid food should not be given until the com- 
pletion of dentition indicates that the powers of 
digestion and assimilation are sufficiently devel- 
oped. But the simplest foods are best always, 
and the diet of infants and children, particularly, 
should be restricted accordingly. 

Regularity in the meals is most important. 
Young children who are allowed to eat every- 



THE BABY 103 

thing, at all times, thrive, if at all, in spite of 
their indulgences. 

Indeed, the health of the infant during the 
second year as during the first depends mainly 
upon intelligent and careful feeding. Let it be 
remembered that there is far more danger of 
over-feeding than of under-feeding at this pe- 
riod. When in doubt as to the propriety of 
allowing a particular article of food, give the 
little one the benefit of the doubt by with- 
holding it. 

The child should be undressed and put to 
bed at the same early hour every night — care 
being taken that the sleeping room has been 
well aired and well sunned. Draw the shades 
or the blinds that it may not wake with the sun. 

The midday nap should be taken every day. 

The more time the child spends out-of-doors 
the better. 

The "all wool'' abdominal band should be 
worn at all times — it is even more important 
in summer than in winter — to prevent sudden 
chilling of the surface, and consequent intestinal 
disorders. 

Mental activity at this period should be 
discouraged. The infant should be guarded 
carefully against excitement, particularly against 
mental shock, from surprise of whatever na- 



104 THE BABY 

ture, as, for instance, a sudden unexpected move- 
ment or noise. 

If the child is properly cared for, there need 
be no fear of the dreaded "second summer," 
which has far less dangers than the first, for 
with every day of life it becomes stronger and 
better fitted to survive. That the second summer 
demands fewer victims than the first is a matter 
of record. It is time this grim old ghost were 
laid. 

The Hygiene of Infancy is discussed in 
"Chapter X. 



CHAPTER IX 

The Premature Infant 

NORMALLY, gestation occupies two hun- 
dred and eighty days; children born at 
the end of this period are said to be born "at 
term"; those born earlier are premature. Other 
things being equal, the nearer the birth is to term, 
the greater the chances are that the infant will 
survive; the child born at the end of eight 
months, therefore, is more likely to live than one 
born at the end of seven months. While, of 
course, effort to preserve life is to be made in 
every case, there is little probability of success 
if birth takes place before the end of six and a 
half lunar months (182 days). 

Every case of premature birth demands the 
most constant and watchful care. There is, how- 
ever, much encouragement in the teaching of 
experience — that if life can be prolonged until 
the time when gestation would have been com- 
plete, and if, meanwhile, the weight of the child 
increases, the chances of its existence are almost, 
if not quite as good as those of the infant born 
at term. 

The successful management of the prema- 

105 



Io6 THE BABY 

ture infant depends mainly upon three things: 
warmth, rest, suitable food and feeding. 

The infant born before the end of the eighth 
month must be placed as speedily as possible 
and allowed to remain in an atmosphere that 
has been heated to a temperature of 90° — a de- 
gree of heat that must be maintained with the 
least possible variation. To meet this require- 
ment particularly, special contrivances known as 
incubators have been devised, and are well-nigh 
indispensable to the proper management of these 
cases. They are kept for rental in all large cities, 
generally by dealers in surgical supplies. 

If an incubator cannot be obtained at once, 
a basket may be made to serve the purpose tem- 
porarily. An ordinary clothes basket is well 
lined with flannel, and, save for a small space 
left open for the entrance of air, covered with 
a blanket. A number of bottles, suflScient to 
raise the temperature to 90° when partially 
filled with hot water, are placed inside. These 
bottles are only partly filled, so that either hot 
or cold water may be added according to the 
indications; generally, the temperature in the 
basket should be between 85° and 90°. A 
thermometer is absolutely necessary, of course. 

The infant born before the end of the eighth 
month should neither be washed nor dressed — 



THE BABY 107 

even the diaper should be dispensed with — but 
should be wrapped at once in well-warmed 
cotton batting, and put into the receptacle pre- 
pared for it. (The child may be kept clean by 
placing a quantity of absorbent cotton beneath 
the buttocks to soak up the discharges. This 
should be changed twice a day. The absorbent 
cotton should be in the form of a sheet, not a 
^'wad," and perfectly smooth.) These infants 
should be kept as nearly absolutely quiet as 
possible, in a darkened room. They should not 
be handled or moved unnecessarily. 

For the first twenty-four hours little or no 
food is required; warmth, and sleep, and rest 
are the essential things. But from the second 
day, food should be given hourly, day and night. 

Eight months' infants, if vigorous, may be 
put to the breast — after the milk comes in, not 
before — but generally, breast-feeding is imprac- 
ticable; moreover, the mother's milk is often 
found to be unsuitable in cases of premature 
birth. 

Seven months' babies are not strong enough 
to draw milk from the breast, or to bear the 
handling and exposures which nursing in- 
volves. In these cases, the milk, if suitable, 
must be pumped out and fed from the dropper 
or the bottle. A large-sized medicine dropper,. 



Io8 THE BABY 

SO shaped that a nipple may be fitted over the 
distal end, is a convenient device for adminis- 
tering food. 

The quantity of food required must be deter- 
mined by the conditions in each case, bearing in 
mind the very limited capacity of the stomach. 
At the age of seven months, not more than a 
teaspoonful, and at eight months, not more than 
two or three teaspoonfuls of food should be 
given at a time, in the beginning. These quan- 
tities are to be increased gradually up to from 
I to i^ ounces — eight to twelve teaspoonfuls 
— at each feeding, at the end of four or five 
weeks. At seven months, food should be given 
hourly; at eight months, every hour and a half, 
day and night. In the feeding of the premature 
infant, "whey-cream" mixtures are often useful 
(Table III). Appropriate mixtures of cream 
and milk are shown in Table V. 

The food may be regarded as suitable in 
character and in quantity if it is not rejected 
by the stomach, if it satisfies hunger, and if 
the weight increases from week to week. Fre- 
quent loss of weight for a day or two is com- 
mon, but these losses in favorable cases are 
promptly made up. 

Hunger is indicated by a continuous whim- 
pering. 



THE BABY 



109 



The weight should be taken every second 
dayo If a suitable contrivance for this purpose 
is not furnished with the incubator, the infant 
should be weighed in a shallow pan, properly 
upholstered, into which it should be lifted with 
the greatest possible gentleness. 



TABLE V 
The Premature Infant. — Mixtures of Cream and Milk 



Mixtures, N 




I. 


II. 


III. 






Materials , 




Oz. 


Oz. 


Oz. 






Cream . 
Milk. . 
Lime watet 
Milk-sugar 
Water, etc 




2 
1 
1 
I2| 


4 
1 


If 

5 

i 
16 






Quantity of food 


16 


24 


24 


Formulas ■ 


■fat 

proteins 

sugar 


Per cent. 
I.OO 

0.50 
3.00 


Per cent. 
1.50 

0.75 

4.00 


Per cent. 
2.00 

I.OO 

5.00 



For suitable "whey-cream" mixtures see 
Table III. 



CHAPTER X 

Sleep — Clothing — Exercise — Bathing — Teething — 
General Considerations 

THE new-born baby should sleep eighteen 
out of the twenty-four hours ; indeed, for 
the first two or three days of life, sleep is 
by far the most important consideration. It 
should not be interrupted on any account. As 
age increases, less sleep is required; but until 
the age of two and a half years, when child- 
hood begins, from sixteen to thirteen hours out 
of every twenty-four should be spent in sleep. 
During their waking hours, vigorous infants 
are in well-nigh perpetual motion. Doubtless 
their brains, also, are active, there are so many 
things to be investigated — so that by the end of 
the day's work, they must be pretty well tired 
out. By six o'clock, therefore, the infant should 
be undressed and put to bed; otherwise, it will 
fall asleep a little later from sheer inability to 
keep awake, and under conditions that make 
refreshing sleep and complete rest impossible. 
Undressing the sleeping infant or child in- 
terrupts its sleep and causes more or less dis- 
turbance of the nervous system. All this may 



110 



THE BABY III 

be avoided by having a regular bed hour, which 
should not be later than six o'clock; in a short 
time, a habit of going to sleep at this hour will 
be formed. Generally, the last day feeding 
should be given at from ten to half-past ten 
o'clock in the evening. For the first two or 
three weeks, two night feedings (between lo P.M. 
and 6 A.M.) may be necessary; after a month, 
but one need be given; and at the age of about 
three months, night feeding may be dispensed 
with altogether. Thereafter, the infant should 
sleep continuously from lo P.M. until 5 o'clock 
in the morning, as it will, generally, after the 
accustomed feeding has been withheld for two 
or three nights in succession. If the little one 
wakes during the night, a drink of water and 
change of position will induce it to go to sleep 
again. A soiled diaper or other cause for 
discomfort must be removed, of course. 

The habit of taking a midday nap should be 
established very early. To this end, the infant 
should be undressed and put to bed every day 
between eleven o'clock and noon, and, prefer- 
ably, soon after a feeding. If this practice is 
begun at the age of four or five weeks the child 
will usually go to sleep promptly — as long as 
the daily nap is necessary — if made perfectly 
comfortable, and left to itself in a darkened 
room. 



112 THE BABY 

All babies are not equally docile, of course, 
and in some cases the mother, or the nurse, must 
sit by the crib until sleep closes unwilling eye- 
lids ; so much may be conceded. But the mother 
who would be relieved of a very great burden 
in the end must deny herself the happiness of 
rocking her little one to sleep in the beginning. 

The healthy child should be allowed to sleep 
until it wakes naturally, unless there is a dispo- 
sition "to turn night into day." In this case the 
nap should be taken a little earlier in the fore- 
noon, and should not be prolonged beyond the 
noon hour. If necessary to awaken the infant 
at any time, it should be done as gently as pos- 
sible, and gradually; sudden rousing, with its 
inevitable shock to the nerves, may have very 
serious consequences. 

The youngest infants should have two naps 
during the day — the first and longer one be- 
tween nine and ten o'clock in the forenoon, the 
second not later than four in the afternoon. 
Older infants differ as adults do in their re- 
quirement for sleep ; in some cases, the midday 
nap seems to be unnecessary after the age of 
eighteen or twenty months. 

The important thing is uninterrupted sleep 
at night; sleep at night is not only more refresh- 
ing, but it contributes very much to the comfort 



THE BABY . II3 

and the welfare of the mother, and is the ultimate 
end to be achieved. 

In the case of ill-nourished and weakly 
infants, prolonged sleep may mean the accu- 
mulation of blood in the brain — "passive con- 
gestion" it is called — which may be the exciting 
cause of inflammation. This condition is due to 
sluggish circulation of the blood, which the heart 
lacks the power to keep properly in motion. In 
these cases, the position of the sleeping infant 
should be changed at intervals; it should be 
taught to lie upon the side rather than upon 
the back, and should be turned from one side 
to the other occasionally. 

Sedatives, in the form of '^soothing syrup," 
never should be given. In cases of wakefulness 
or restlessness of which the cause is not known, 
a warm or hot bath meets the requirements much 
better than drugs, and cannot do harm. Infants 
are peculiarly susceptible to opium in any form; 
even a small dose may be fatal. Moreover, the 
causes of sleeplessness and fretfulness cannot be 
removed by remedies of the kind, which mask 
the real disorder, and may create others far 
worse. 

An early bed hour throughout the periods of 
infancy and childhood is an essential condition 
of normal development — particularly, normal 
development of the nervous system. 



114 THE BABY 

CLOTHING 

This is a matter with which fads and fashion 
should have nothing to do. The infant's cloth- 
ing should be chosen solely with regard to ade- 
quate protection from cold, and to freedom of 
movement and comfort. Especial reference has 
been made to the sensitiveness of the infant 
to cold and its feeble power of resistance. It 
is most important that all parts of the body 
should be protected against cold; not only the 
general cold of winter, but equally against a 
rapid cooling of the surface, as from changes 
of temperature or equivalent causes. And in 
the clothing this should be among the first 
considerations. 

Of the materials suitable for underwear, 
woolen is best because it is the poorest conductor 
of heat; silk comes next in this regard. Even 
a thin covering of woolen will prevent sudden 
chilling from exposures, because the heat of the 
body can get through it but slowly; accordingly, 
the abdominal band should be knitted with wool 
or made from flannel — and it should be worn the 
year round. The protection given by it lessens 
very much the liability to bowel troubles ; next 
to proper food and feeding, it is the most effec- 
tual preventive of diarrhoeal diseases in very hot 
weather. Bands of at least three degrees of 



THE BABY II5 

weight or thickness should be provided. If 
woolen irritates the skin, they may be lined with 
old linen. The abdominal band should extend 
upwards only as far as the lowest ribs, and should 
fit snugly enough to give support to the walls of 
the abdomen, without, however, interfering with 
their free movement. This movement is essen- 
tial to abdominal breathing, by which alone the 
lungs are properly expanded. 

With this exception, all the clothing should 
be loose, particularly about the neck and the 
chest, that the lungs may have free play, and that 
the passage of the blood through the great ves- 
sels that convey it to and from the brain may 
not be impeded; the least constriction about the 
chest hinders the entrance of air into the lungs, 
while pressure upon the veins in the neck, if 
sufficient to interfere with the blood current 
therein, may in itself give rise to the ''passive 
congestion" of the brain that has been referred 
to. The fact that air is a bad conductor of heat 
furnishes another reason for having the under- 
clothing loose, for the air imprisoned between 
it and the skin still further prevents loss of the 
body heat. 

The head should be well covered both in 
winter and in summer. Its exposure to cold 
may give rise to various disorders, particularly 



Il6 THE BABY 

to inflammation within the ear; and direct ex- 
posure to sunlight involves danger from ab- 
sorption of its chemical rays, which are more 
injurious than its heat rays. Chemical rays are 
intercepted by dark-colored fabrics — the darker 
shades of red are most efl5cient. 

Especial care should be taken to keep the 
feet and the legs warm, since the circulation of 
the blood is feeblest in the extremities that are 
farthest from the heart. The stockings — at all 
seasons of the year — should be long enough to 
be pinned to the diaper, and the legs should be 
covered. When the infant is vigorous enough 
to kick oE the bed coverings, night drawers, 
made of flannel for winter, should be provided. 

But clothing, it may be repeated, does not 
create warmth; it only prevents undue loss of 
the heat that is generated in the body. If the 
garments are properly made, of suitable mate- 
rial — and "all-wool" fabrics are best for under- 
wear — all its purposes may be accomplished, as 
they should be, without ''bundling'' the child 
up, or interference with the perfectly free move- 
ments of the body that materially assist the cir- 
culation of the blood and the distribution of the 
body heat. For while this constant movement 
of the blood depends mainly upon the muscular 
power of the heart, it is aided by other agen- 



THE BABY II7 

cies, of which muscular contraction is the most 
important one. 

EXERCISE 

Exercise is muscular contraction mainly. 
By assisting the passage of the blood, through 
the veins particularly, and by increasing the 
number and the force of the heart-beats, exer- 
cise promotes the nutrition of the body in all 
its parts; it quickens and deepens the breathing, 
also, so that a larger number of the air-cells of 
the lungs are expanded; accordingly, more air 
enters the lungs, and the blood is more liberally 
supplied with oxygen. 

There is good reason, therefore, for the natu- 
ral activity of the infant, which should be en- 
couraged in every way. Even the youngest 
should have opportunity for the daily exercise 
of its muscles; to this end, it should be un- 
dressed, save for the shirt and the abdominal 
band, wrapped loosely in a light blanket, and 
left for twenty minutes every day to the per- 
formance of such gymnastics as it may be capa- 
ble of. The "exercise" should be taken from 
one to two hours after a feeding. 

As soon as the child can sit without support, 
it should be put on the floor, care being taken to 
exclude draughts, where it should spend the 
greater part of its indoor day. 



Il8 THE BABY 

At the age of a month, it may be taken out- 
of-doors in warm weather, and only in warm 
weather; during the fall and winter months — in 
temperate climates — it should be kept indoors 
up to the age of three or four months. 

Until the infant can be supported by pillows 
in the sitting posture, it should not be "wheeled," 
but always carried in the arms, when taken out- 
of-doors. And it never should be laid on its 
back in the baby carriage, unless for an outdoor 
nap in midsummer; later, care should be taken 
that its position is changed to the side. Where 
the child is strong enough to sit without props, 
it should be taken out every pleasant day, and the 
more time it spends out-of-doors the better; but 
the outing should not be extended beyond four 
o'clock in winter, or beyond about five o'clock 
in summer. Sun light and sun warmth, provided 
the head and the body are properly protected 
from direct exposure, are peculiarly beneficial. 
The face should not be covered except in cold 
weather. 

Exposure to high winds and a dust-laden 
atmosphere should be especially avoided. Per- 
fectly healthy infants may develop a disease of 
the skin called eczema, due entirely to exposure 
to cold, or other atmospheric conditions by which 
the skin is irritated. 



THE BABY II9 

The child should not be encouraged to walk, 
or to stand, even if supported, before it is a 
year old. 

BATHING 

The reaction in the case of the healthy adult 
which makes the cold bath stimulating and tonic 
is utterly wanting in the case of the infant, upon 
whom its effect is altogether depressing. In 
early infancy sudden cooling of the surface, by 
which the superficial blood vessels are con- 
tracted and the blood driven into the interior, 
may be the exciting, or a predisposing cause of 
inflammatory disease, as of intestinal affections 
(diarrhoea) and bronchitis. 

Water at any temperature — even one degree 
— below that of the blood, 98^°, is cold, or cool^ 
in contact with the warmer skin, and its immedi- 
ate evaporation takes more or less heat from the 
body (depending upon its own temperature). 
Indeed, the even temperature of the body in 
health — whatever external conditions of heat 
and cold may be — depends mainly upon the 
evaporation of the water that is constantly 
poured out by the sweat glands, and of which 
the amount is regulated automatically accord- 
ing to the need. In the beginning, then, the 
temperature of the water should be about that 
of the blood, or between 99° and 98°; if the 



I20 THE BABY 

infant is vigorous, it may be reduced gradu- 
ally to reach 95° at the age of six months, and 
90° at the end of the first year — but it should 
not be carried below 90° within this period. 
This gradual reduction of temperature should 
be continued up to the end of infancy — at two 
and a half years — when the bath may be given 
at 80°. In infancy, a bath from 90° to 80°, 
according to age and vigor, is ''cold"; from 98° 
to 90°, ''cool"; from 99° to 100°, "warm"; from 
100° to 103°, "hot." 

The vigorous infant should have a "cool" 
bath every morning; for purposes of cleanli- 
ness, soap — of the best quality, unscented, as 
white castile soap — maybe used daily for cleans- 
ing the hands, the head (scalp), and the but- 
tocks, or other parts that have been directly 
exposed to soilure; but a full soap bath once a 
week is quite often enough ordinarily. 

Until the infant can sit up without support, 
only the "sponge bath" should be given. 
"Sponges" for the purpose should be made up 
from cheese cloth, compactly folded into pads 
small enough to be covered by the hand; the 
flopping ends of a large wash-cloth convert 
the daily bath into a daily infliction. Sponges 
should not be used, as it is well-nigh impossible 
to keep them clean. In winter, the bath should 



THE BABY . 121 

be given in a warm room — not below 72° — and 
if all the clothing is removed at once, the body 
and limbs should be kept covered with a blanket 
until the head, neck, and face have been washed 
and dried. Particular care should be taken from 
the outset to cleanse the nostrils and the nasal 
passages; bits of foreign material, or dried mu- 
cus, in the nose are likely to interfere with the 
free nasal breathing that is absolutely essential 
to the well-being of the infant. 

The bath should not be prolonged, and the 
manipulation should be as rapid as may be con- 
sistent with gentleness. The body and limbs 
having been washed and dried, the creases and 
folds in the skin may be lightly sprinkled with 
^^baby powder" to prevent chafing. Powders 
that contain starch are unsuitable; in the pres- 
ence of moisture, this substance forms little rolls, 
or balls, that are likely to cause irritation. 

A full sponge bath should not be given until 
after the remnant of the cord has separated; or, 
at any period, within an hour after a feeding. 
When the child is old enough and strong enough, 
it may be put into the bathtub to kick and splash 
for a few minutes, and only for a few minutes ; 
but the washing should be done in the lap always. 

Apart from purposes of ordinary cleanliness, 
the infant's bath at the usual temperatures stim- 



122 THE BABY 

ulates the circulation of the blood in the surface 
blood vessels, and rids the skin of the waste prod- 
ucts that are left upon it by the evaporation of 
the water of the perspiration. The activity 
of the sweat glands is constant, and what is 
known as the "insensible perspiration" and 
evaporation are always going on. These waste 
matters, therefore, are all the time accumula- 
ting; if allowed to remain on the skin they clog 
rhe mouths of the sweat ducts, and being bad 
conductors of heat prevent its rapid escape from 
the body — and this escape, in hot weather par- 
ticularly, is an important matter. These waste 
products are freely soluble in water, plain water; 
soap is not required for their removal, therefore. 
Moreover, soap dissolves the oily secretions of 
the little glands (sebaceous glands) in the skin 
that serve to keep it soft and flexible; for these 
reasons, washing with soap should be limited 
for the most part to exposed parts of the body 
— as the hands and the head and neck. 

Even within the narrow limits which the 
feeble vitality of the young infant prescribes, 
the effect of a bath depends considerably upon 
the temperature of the water. The distinctly 
warm or hot bath is often exceedingly useful, 
not to take the place of the bath at the usual 
temperature, but as an additional means of pro- 



THE BABY 1 23 

moting the child's welfare and comfort. Thus, 
if the little one is tired and hot, or excited, or 
nervous, a warm or hot bath — 99° to 102° — 
at bed hour will often bring quiet and sleep 
promptly. And in hot weather, particularly if 
there is a high degree of humidity also, it may 
be given several times during the day with the 
happiest effects. A hot bath cools the body 
in three different ways: (i) by expanding the 
superficial blood vessels so that the heat radi- 
ating surface is increased in extent; (2) by 
increasing the activity of the sweat glands so 
that more water is poured out to be evaporated; 
(3) by removing the waste products referred to 
so that heat escapes more readily and rapidly. 
But the warm or hot bath should not be pro- 
longed, on account of its generally relaxing and 
depressing effect in this case; and immediately 
after it, the child should be kept quiet, or in- 
duced to lie down for half an hour. 

If after the bath at the usual temperature, 
the infant is languid; if the lips take on a bluish 
tinge and the extremities are cold, tub bathing, 
or splashing, should be at once suspended, and 
sponge bathing limited to the absolute require- 
ments of cleanliness; in these cases, only warm 
or tepid water should be used, and the after 
rubbing should be as vigorous as may be without 
roughness. 



124 



THE BABY 



TEETHING 

Normally, dentition begins between the sixth 
and the seventh months, and the first set of teeth 
— called the milk teeth — is complete at the age 
of about two and a half years. There are twenty 
milk teeth — ten in each jaw — which are divided 
and named as follows: four incisors (in front) ; 
four molars (jaw teeth) ; two canines (situated 
between the incisors and the molars). The fol- 
lowing table shows the number of teeth of each 
kind in both the upper and the lower jaws. The 
corresponding teeth in each jaw usually make 
their appearance at about the same time: 



Name 

Number in each jaw . . . 
Date of eruption (in months) 



Incisors 


Canines 


4 


2 


9-7-7-9 


i8 



Molars 

4 
ia-30 



The opinion has prevailed among medical 
men, and is still generally held by the laity, that 
dentition, directly or indirectly, is a common 
cause of illness. This belief is erroneous, and 
mischievous in that it invites the error of attrib- 
uting symptoms of serious illness to teething 
as a cause, to the neglect of the real trouble; 
even pneumonia and ^'inflammation of the 
brain" have been thus overlooked. The popu- 



THE BABY . 1 25 

lar notion that diarrhcea occurring at this time 
is not only to be ascribed to teething, but should 
be regarded as rather desirable than otherwise, 
is a popular fallacy; this symptom is never 
directly due to the eruption of the teeth, and 
it certainly never has a favorable influence. 
While, therefore, dentition, which is purely a 
physiological process, is by no means respon- 
sible for all the evils charged against it, and 
is never the sole and direct cause of illness, it 
doubtless operates as a contributory cause, in 
common with other developmental changes; 
indeed, the activity with which during this 
period, these changes are going on in every part 
and organ of the body doubtless accounts for 
the susceptibility of the infant to disease. The 
"diarrhoea of teething," for example, may be 
dependent to some extent upon developmental 
changes in the intestines. 

The routine practice of lancing the gums — 
based upon other venerable errors — is no longer 
followed, though the doctor is still summoned 
for the purpose. Occasionally, when the con- 
gestion and swelling of the gums are sufficient 
to cause pain, the knife may be used with advan- 
tage to divide the sensitive nerve-filaments in- 
volved; but an incision over the tooth hinders 
rather than assists its eruption, for the cut heals 



126 THE BABY 

very quickly, and the resulting "scar tissue" is 
denser and more resistant than the natural gum. 
The possibility of infection of the wound made 
by the lancet, and a consequent abscess, must 
not be overlooked. 

A "teething ring" of India rubber or of 
ivory seems to afford considerable relief, and 
its use is unobjectionable. Attempts to "rub the 
tooth through" only add to the local irritation, 
and are worse than useless. 

GENERAL CONSIDERATIONS 

The nurse, or attendant, should be chosen 
carefully, and with discrimination; if she is to 
have the entire charge, even of the feeding, a 
trained nurse should be employed, generally. 
But she must be one of the many trained nurses ; 
the few who regard the knowledge obtained 
in the training school as the end of wisdom, 
who find nothing to be learned and nothing to 
be unlearned — often the more important and 
always the harder lesson — are utterly unfit for 
this service. If the nurse is to be an assist- 
ant only, under the constant supervision of 
the mother, previous training is unnecessary, 
and experience undesirable; the "experienced" 
nurse, without training, is always largely expe- 
rienced in error, and whatever the number of 



THE BABY 1 27 

her years will be found too old to learn. In 
any case, intelligence, aptitude, and interest are 
the most important qualifications. 

The attendant, even if employed only to 
wheel the baby out, must be old enough and 
intelligent enough to recognize the responsibili- 
ties of her office and the importance of doing 
exactly as she has been told to do. She should 
be in good health, of an even temper, "fond 
of babies," and clean — of body and of mind. 
Always, the special caution must be given that 
the baby is not to be kissed upon the lips — by 
anybody. Very serious diseases have been com- 
municated to infants through neglect of this 
caution. 

When held, or carried in the arms, the 
infant's back should be supported; most babies 
have a way of throwing themselves suddenly 
backwards, not only at the risk of escaping from 
the arms and getting a bad fall, but of producing 
a rupture (hernia) from the strain put on the 
abdominal walls. 

The infant should not be encouraged to stand, 
or to make attempts at walking, until it is a year 
old, at least. Some infants do not try to walk 
until well along in the second year; and there 
need be no apprehension on this account. Stand- 
ing, or walking, before the feet and legs are 



128 THE BABY 

Strong enough to support the weight of the body, 
is attended by risk of breaking down the arches 
of the feet (insteps) and of crooking the legs. 

As soon as the child begins to walk, the feet 
should be fitted with "right" and "left" shoes, 
so that the arch of each foot may be supported. 
Doubtless, the deformity known as "flat-foot" 
is caused not infrequently by premature efforts 
to stand, or to walk, and by the ill-shaped shoes 
that are provided for the human foot — from 
infancy even to old age. 

The uses of the commode may be taught very 
early. As soon as the child is strong enough to 
sit up without support it should be put onto a 
suitable toilet chair, every two or three hours if 
necessary, until its use has been learned; after 
that, two or three times every day, at the same 
hours. Generally, regular habits are speedily 
formed, and the infant will make known its 
wants at other than the usual hours by signs 
that may be readily interpreted. The year-old 
infant, if put on the chair at frequent intervals, 
will soon recognize and improve opportunities 
by which the discomforts of a wet diaper may 
be averted. 

For obvious reasons, and particularly because 
of the risk of exposure to contagious diseases, 
travel should be eliminated as far as possible. 



THE BABY 1 29 

The street car in winter and the closed public 
carriage are especially to be avoided on this 
account. 

The child's sleeping room should be the 
sunniest and airiest in the house. And both 
sunshine and fresh air should be admitted 
freely, the more abundantly the better. This 
room should not be carpeted; either a hard 
wood, or a smooth painted floor is much to be 
preferred. The less upholstery the better; not 
only is the air likely to be purer at all times in 
a plainly furnished room, but in event of ill- 
ness, particularly from the contagious diseases 
to which children are especially liable, the 
little patient will do better, and the risk of 
harboring the contagion will be very much 
less. At the age of five months the baby may 
be vaccinated. 

In every respect, the furnishings and arrange- 
ments of the nursery should be such that the 
little one is not constantly falling into ''mis- 
chief"; things that it ought not to have should 
be put beyond its reach, or removed entirely, if 
practicable. Only that which is harmful, or 
otherwise unsuitable for it, should be denied 
the child, who should be given the utmost free- 
dom to investigate. Anything once forbidden 
should be forbidden always; otherwise the les- 



130 THE BABY 

son of obedience will be but slowly and 
imperfectly learned. 

Habits are readily acquired; and good habits 
are so desirable that the effort to establish them 
is well worth making. But we must not expect 
to govern the affairs of the nursery by rules, or 
suppose that all infants may be managed in 
precisely the same way. While the feeding and 
the bathing and the care of the child generally 
should rest upon the principles that we have 
been considering, knowledge of principles is not 
in itself enough ; they must be applied with good 
judgment, with discretion, above all, with com- 
mon sense and in appreciation of the fact that the 
infant is an individual, with individual pecul- 
iarities for which due allowance is to be made. 
But to make the exceptions one must know the 
rule. 

It should be remembered that the young 
child is the young animal of the human species; 
its needs are physical. After they have been] 
met, the less attention it has the better. Effortsl 
to amuse it, for the first year at any rate, arei 
misplaced; the spirit of investigation being in- 
herent, and all things new and strange — all 
equally strange — the infant will find quite 
enough exercise for its feeble mental powers 
if left to itself. Teaching should be limited to 



THE BABY 131 

the endeavor to establish good physical habits 
— habits that will contribute to its own and to 
the mother's comfort and well-being. 

Precocity should be discouraged. The 
accomplished infant is a monstrosity. 



CHAPTER XI 

Disease in Infants — Infantile Ailments 

IN event of sickness, the responsibility should 
be at once transferred to the physician, who 
alone is competent to direct the care of the little 
patient. And the earlier the doctor is called in 
the better. It is desirable, however, that the 
mother should have some knowledge of the signs 
of illness, and be able to distinguish between 
symptoms of a trivial and those of a serious 
nature, that, on the one hand, she may not suffer 
needless anxiety, nor, on the other, neglect to have i 
medical advice in the belief that the services of 
the physician are not required. 

Between the infant and the adult there are 
certain physiological differences, particularly 
in the action of the heart as indicated by the 
pulse; in the respiration and in the temperature, 
which must be taken into account in determining 
the degree of illness. In the average healthy 
adult, the pulse beats about 72 times a minute, 
and the respirations number 18 per minute; in 
the infant, the action of both heart and lungs is 
much more rapid. At the age of one month, 
the pulse is 130; respirations 42 per minute; 

132 



THE BABY ' 1 33 

at the age of one year, the pulse is 120; respira- 
tions 40. Both decrease in frequency with age, 
though at five years the pulse is from 90 to 100, 
and the respirations about 25. In infancy, and 
to a less degree in childhood also, pulse and res- 
piration are very much accelerated by exercise 
and by mental excitement; slight ailments, too, 
especially of the digestive apparatus, are at- 
tended by a disturbance of these functions that 
is altogether out of proportion to the gravity 
of the disorder. Infants and children develop 
a high fever also from comparatively trivial 
causes. 

These peculiarities add not a little to the 
difficulties — of diagnosis in particular — that 
disease in infancy presents. In event of illness, 
the little patient can tell us nothing, having "no 
language but a cry," save by signs that are often 
misinterpreted. In many cases, knowledge of 
the real condition can be gained only by a phys- 
ical examination for which the special training 
of the physician is necessary. 

The healthy infant should be active during 
its waking hours; its flesh (muscles) should be 
firm and hard; its skin smooth and elastic; its 
joints supple; its eyes full and bright; its com- 
plexion clear; it should sleep quietly and lie in 
a natural and easy position, and it should be 



134 THE BABY 

good-humored. A "fat" baby is not necessarily 
a healthy one; on the contrary, accumulation of 
fat is not desirable, since it interferes with activ- 
ity. The muscles of a very fat baby are apt to 
be flabby for this reason, its digestion to sufifer, 
and its powers of resistance to be weakened. 

Peevishness, restlessness, drowsiness, indis- 
position to exercise and amusement are all signs 
that the child is not well, and as such demand 
investigation. In cases of illness much may be 
learned by careful observation of the attitude, 
movements, facial expression, etc. 

Carrying the hand to the head, pulling the 
hair, rolling the head uneasily on the pillow, 
are signs of pain in the head; firm retraction 
of the head, flexure and rigidity of the limbs, 
spasm of the muscles, and a shrill cry indicate 
serious brain disease; a disposition to lie so as 
to make pressure on the abdomen and flexure 
of the thighs on the abdomen are evidences of 
abdominal pain; rubbing the nose and grinding 
the teeth are signs of intestinal irritation from 
some cause; forcibly striking the nose is a symp- 
tom of brain trouble (this movement appears to 
be the precursor of convulsions in some cases). 
Squinting, when not dependent on defect of the 
muscles of the eye, indicates brain disease. A 
downward direction of the eyes, smallness of the 



THE BABY . 1 35 

face, and great expansion of the cranium are 
signs of "water on the brain." Enlargements 
at the joints (the ends of the long bones), a 
large, square-shaped head, and delayed denti- 
tion are signs of rickets. 

In pleurisy and pneumonia the voice is re- 
strained and abrupt, and the breathing rapid 
and shallow; in croup, or when the windpipe 
is obstructed, hoarse and metallic. Moaning is 
characteristic of diseases of the intestinal canal. 
A "sharp, shrill, and solitary" cry indicates 
very serious brain trouble. Continued crying 
without discoverable cause, the child being well 
apparently, is likely to be due to earache. 

In brain disease, the expression of the upper 
part of the face is involved: the brows are con- 
tracted; the eyes fixed, squinting, or vacant. In 
affections of the heart and the lungs, the nostrils 
dilate with the inspirations; the lips are blue; 
there are dark rings under the eyes. In abdomi- 
nal diseases, the mouth is drawn; the lips pale or 
livid; the cheeks sunken. 

INFANTILE AILMENTS 

The infant is peculiarly liable to certain 
ailments and disorders, some of them of but 
little importance in themselves, but which, 
nevertheless, may seriously interfere with its 



136 THE BABY 

comfort and well-being, and add very much to i 
the mother's burdens. Some of these disorders 1 
are due probably to developmental changes; 'i 
but many proceed from causes that may be pre- 1 
vented, or, at any rate, removed, once they are ] 
determined, as they should be always, if possi- 
ble. Slight disorders are often neglected for no 
better reason than that all or most babies have 
them; they are regarded as necessary evils — 
like the cutting of teeth. 

A fretful baby is rather likely to acquire 
reputation in the family as a ''cross" baby, who 
must be humored, but ought to be disciplined. 
Both methods of treatment are wrong, however; 
for unless a peevish habit has been established 
as a result of continued illness, or other sufficient 
cause, fretfulness means discomfort, or pain from 
some source; it is abnormal, for the normal 
infant in health is "good." The little one may 
be fussy at bed hour from weariness and cry 
lustily at times in wrath, but exhibitions of this 
nature are quite normal for most of us, and most 
babies have all too frequent cause for righteous 
indignation. But the vigorous crying that re- 
lieves the mind probably, and expands the lungs 
certainly, is one thing; the "worrying" of the 
fretful baby is quite another and a different 
matter altogether, of which the cause must be 



THE BABY 1 37 

sought diligently: it may be discomfort merely, 
as from some fault in the clothing or the dress- 
ing; it may be hunger or thirst; or, as perhaps 
most commonly, slight indigestion; and it may 
be, also, an early sign of very serious disease. 

Hunger, as already pointed out, may depend 
upon over-frequent feedings, or upon lack of a 
sufficient amount of proteins in the food. In the 
former case, particularly, symptoms of indiges- 
tion are usually present, viz. : regurgitation of 
food, vomiting, ^'wind on the stomach," dis- 
tended abdomen, diarrhoea (or constipation), 
the presence of whitish masses, or lumps, in the 
stools, etc. These symptoms are generally due 
to errors in diet, and the correction of these 
errors is the sufficient remedy in most instances, 
though medical treatment also may be necessary. 
Indeed, whenever there are evidences of dis- 
ordered or diseased conditions, it is always best 
to consult the doctor without delay; for while 
it almost necessarily belongs to the mother and 
the nurse to keep the baby well, the care of the 
sick baby demands the special knowledge and 
training of the physician. 

If discomfort, hunger and thirst, and abdom- 
inal pain from indigestion can be eliminated, 
f retfulness is most likely to be caused by earache, 
though in inflammatory disease of the ear, the 



138 THE BABY 

pain rapidly becomes so severe that the child 
cries from it. Again, it may mean beginning 
disease of the spine, or of the hip, or other 
joints ; in this event, the infant usually has fits of 
crying, or screaming, during the day, and, par- 
ticularly, cries out in its sleep at night. This cry, 
or scream, in the night is so characteristic that 
its repeated occurrence calls imperatively for 
examination by the surgeon that disease, if 
present, may be discovered and treated at once. 

If the infant frets, or cries, when taken up, 
or moved, the possibility that it is suffering from 
scurvy should not be overlooked. 

Disorders and diseases to which the youngest 
infants are especially subject are: jaundice, con- 
stipation, diarrhoea, regurgitation of food, ^'wind 
colic," inflammation of the eyes, of the skin, and 
of the breast. 

JAUNDICE 

Although referred to as a disease, jaundice is 
a symptom of disease, or disorder. In the young- 
est infants it is usually caused by a functional 
disturbance of the liver. It is recognized by 
the yellow discoloration of the skin and eyes 
to which it gives rise. This appearance is apt to 
give the mother a good deal of anxiety; but it 
is of no importance and disappears in a few 
days without treatment. 



THE BABY 1 39 

CONSTIPATION 

In the case of the youngest infants, constipa- 
tion may be overcome sometimes by giving water 
in the morning before any food is taken, and 
through the day immediately after each feeding 
or nursing. In the preparation of food for the 
bottle baty, oatmeal water should be used as 
the diluent rather than barley water or plain 
water. The percentage of fat in the food may 
be increased; or if already large, decreased; 
and the percentage of proteins diminished^ 
with benefit in many cases. 

A small piece of castile soap, or of molasses 
candy, inserted into the rectum is often useful. 
Rectal injections of water are of small service 
because the rectum holds so little; the addition 
of a little glycerin — ten or twelve drops — to the 
water makes it more effective. Glycerin is indi- 
cated particularly if the excrement is dry and 
hard. A teaspoonful, more or less, of olive oil 
may be thrown into the rectum with good re- 
sults; and the injection, once a day, of a small 
quantity — five to ten drops to begin with — of 
olive oil to be retained — the amount to be in- 
creased gradually, if necessary, up to as much 
as the rectum will tolerate — is very often cura- 
tive. The injection is best made at bedtime, as 
the infant should be as quiet as possible after 
receiving it. 



140 THE BABY 

Purgatives should not be employed in this 
condition ; they only add to the trouble. Castor 
oil, so useful as a laxative in many conditions 
on account of its astringent after-efifect, is to be 
avoided in the treatment of constipation. 

SIMPLE DIARRHOEA 

In the youngest infants this disorder seldom 
calls for medicinal treatment. The daily quan- 
tity of food should be reduced, and the food 
should be further diluted — this may be done by 
giving a few teaspoonfuls of water directly after 
each feeding. Generally, also, the percentage 
of fat in the food should be decreased. 

From two to four movements of the bowels 
in twenty-four hours may be regarded as normal. 
Indications of intestinal disorders or disease re- 
quiring medical advice are: frequent move- 
ments, particularly if they are accompanied by 
straining or vomiting, with the presence of mu- 
cus, blood, shreds of membrane, or curds in the 
discharges. At all ages, looseness of the bowels 
furnishes an indication for an immediate reduc- 
tion of the quantity of food, particularly of the 
quantity of the fat. 

REGURGITATION 

Occasional regurgitation (spitting up) of 
food immediately after a feeding is perfectly 



THE BABY 141 

compatible with health, and may be conserva- 
tive; if more food has been taken into the 
stomach than can be digested, it is certainly 
better that the excess should be rejected. The 
bottle baby almost always swallows air with 
food; when the air is expelled from the stomach 
some of the food is likely to be expelled with it. 
This may often be avoided by raising the infant 
to the sitting posture immediately after the food 
has been taken — when the air will be at once 
discharged by itself. 

Persistent regurgitation of a considerable 
quantity of the food calls for treatment; the 
trouble may come from over-feeding; from 
insufficient dilution; from too much fat in the 
food, or from fermentation of the food in 
the stomach (though in this case, the regurgi- 
tation does not occur immediately). The 
remedial measures must be directed accord- 
ingly: if, in the case of the infant at the breast, 
the milk is too rich, a few teaspoonfuls of 
boiled water may be given immediately before 
or after each nursing; if the regurgitation is 
caused by over-feeding, the intervals between 
meals should be lengthened; if to fermentation, 
extraordinary pains should be taken to insure 
perfect cleanliness of the nipples — or of the 
bottle — and of the mouth also, and appro- 
priate remedial measures adopted to prevent 



142 THE BABY 

it. If substitute-feeding is employed, the milk 
supply should be looked after. 

INFLAMMATION OF THE EYES 

The eyes of the youngest infant are extremely 
sensitive; exposure to bright light or contact 
with slight irritants, as soap, for example, may 
give rise to inflammatory trouble of consider- 
able severity. The introduction of foreign 
material between the lids, an accident that 
sometimes occurs in birth, may cause very seri- 
ous trouble; on this account, careful cleansing 
of the face and eyes of the child is the first 
and one of the most important duties of the 
nurse. 

Slight inflammation may be effectually con- 
trolled by keeping the little patient in a darkened 
room, with cold compresses (soft linen cloths 
wrung out in cold water) over the eyes. These 
compresses should not be so thick as to be bur- 
densome on account of their weight, and they 
should be frequently changed. If marked im- 
provement does not follow within a day or two 
the eyes should be bathed in a lotion composed 
of five grains of borate of soda and i ounce of 
camphor water, a few drops of which should be 
instilled into them several times a day. Should 
these measures fail, the case must be referred to 
a physician without delay. 



THE BABY 143 

This treatment applies only to cases in which 
the inflammation is of a mild grade, with little 
or no discharge of "matter'' from beneath the 
lids. The affection that begins with consider- 
able intolerance of light and slight swelling 
of the lids, the child being restless and wakeful, 
and advances rapidly until, within twenty-four 
hours perhaps, the lids are greatly swollen, the 
eyes red, and there is an abundant discharge of 
pus, with extreme sensitiveness to light — this is 
an exceedingly dangerous disease, and is likely 
to destroy the sight if appropriate treatment is 
not begun at once, and very faithfully carried 
out. The doctor must be called in immediately. 
In this condition, the frequent and thorough 
removal of the pus from beneath the lids is of 
the utmost importance; they should be sepa- 
rated and the space between them freed from 
the secretion by a camel-hair brush, or by gentle 
syringing with tepid water; in the interval, com- 
presses wrung out in ice water and renewed 
every two or three minutes must be kept con- 
stantly applied night and day. 

INFLAMMATION OF THE SKIN 

Inflammation of the skin (dermatitis) and 
of the breast (mastitis) are among the diseases of 
earliest infancy. The former gets well without 



144 THE BABY 

treatment, and a spontaneous cure of the latter 
may be expected if the breasts are not irritated 
by manipulation, or otherwise; the temptation 
to squeeze the nipple, therefore, must not be 
yielded to. Should the breasts become hot, 
swollen, and painful, poultices of linseed meal 
are advised; in such event, howxver, the case 
is one for the physician. 

The wax-colored incrustation that appears 
on the scalp, at the age of six or eight weeks 
generally, is the dried oily secretion of the seba- 
ceous glands. These glands are very active dur- 
ing the first year, but at the end of this time their 
extraordinary activity ceases, and the secretions 
dry up and fall off, leaving the scalp in a healthy 
condition usually. But the appearance, mean- 
while, is unsightly, and the condition is an un- 
cleanly one. The scalp may be cleaned by 
softening the mass with olive oil, and after- 
wards washing it off with soap and water. 

THE CORD (navel) 

If the cord is properly dressed in the first 
place (see page 6) and is not disturbed after- 
wards, it dries and drops off between the sixth 
and the tenth day, leaving a perfectly healed 
stump. If, instead of this, the part is left moist 
and ^^sore," it should be well washed with warm 



THE BABY . 1 45 

(boiled) water and immediately dusted with 
powdered starch which has been heated in the 
oven for half an hour, or until slightly browned. 
Under this dressing, a dry scab is soon formed, 
which, if not interfered with, drops off in a few 
days, when healing will be found to be complete. 
Care should be taken that the hands are clean 
before applying the dressing. 

A small bunch, or tumor, at the navel, which 
disappears under gentle pressure only to reap- 
pear when the pressure is removed, indicates a 
rupture (hernia). 

"blue-babies" 

In these cases (cyanosis), the dusky color of 
the skin is caused by the accumulation of car- 
bonic acid gas in the blood and the lack of 
sufficient oxygen. This condition results from 
some defect, generally malformation or lack of 
development in the heart or in the great central 
blood vessels. Even when due to malformation, 
the dusky color is not always apparent at, or 
immediately after birth, but it usually shows 
itself before the end of the first week. Excep- 
tionally, cyanosis does not appear until near 
the end of the period of infancy. The manage- 
ment of these unfortunate cases belongs to the 
physician. 



CHAPTER XII 

Infantile Ailments Continued — Accidents and 
Emergencies 

AMONG the common ailments to which 
infants of all ages are subject are colic 
and diarrhoea due to indigestion. 

COLIC 

The attitude of a child suffering from a 
severe attack of colic is characteristic; it lies 
with its knees drawn up and the thighs flexed 
upon the abdomen, the instinctive purpose being 
to relax the abdominal muscles. The pain is 
paroxysmal; the child cries out suddenly and 
as suddenly becomes quiet, the pain passing off. 
When these symptoms are present the case is 
one for the physician, who should be summoned 
at once. 

We shall consider only the milder forms of 
the disorder, which perhaps few babies escape 
altogether. These are due to the accumulation 
of gas in the bowels, the result of fermentation 
(indigestion), in which the pain is probably 
caused by spasm of the muscles of the walls of 
the intestines, with perhaps slight over-disten- 

146 



THE BABY 1 47 

tion of them. A discharge of flatus affords 
immediate relief; the object of our treatment, 
therefore, is to promote the expulsion of the 
gas, quiet the pain, and correct the indigestion. 
The expulsion of the gas may be greatly assisted 
by massage, which should be employed in this 
way: One hand is placed at the child's back, 
the other on the right side of the abdomen, a 
little above the level of the hip bone ; from this 
point it is moved, with gentle pressure, slowly 
along the course of the large intestine; that is, 
directly upwards, thence, on a line that passes 
a little below the lower border of the stomach, 
straight across from right to left and down on 
the left side. These movements are to be re- 
peated until their purpose is accomplished. For 
the relief of pain hot applications are useful. 
Dry heat is better, but in the absence of facilities 
for applying it, flannels dipped in hot water, 
wrung as dry as possible, and constantly renewed, 
may be employed. At the same time the extrem- 
ities must be well warmed. Hot applications to 
be effective must be made hot; at least two pieces 
of flannel should be provided to be used alter- 
nately, and changed as rapidly as they can be 
heated, or wrung out in hot water, as the case 
may be, in order that the application of heat may 
be as nearly continuous as possible. Afterwards, 



148 THE BABY 

the abdomen should be covered with a generous 
piece of dry flannel. A laxative, and none is 
better for the purpose than castor oil, is needed 
to complete the cure. The faulty digestion must 
be corrected, of course, to prevent further at- 
tacks. In its severer forms, colic is an exceed- 
ingly painful affection, which yields only to the 
influence of anodynes that cannot be used with 
safety except under the direction of the physi- 
cian. The pain of colic is distinguished from 
pain due to inflammation: (i) by the fact that 
it comes in paroxysms; (2) it is diminished 
rather than increased by pressure. 

DIARRHOEA 

This disorder is often due to the presence 
of undigested food in the intestines ; under these 
circumstances, it represents an effort of nature 
to expel the offending material; if the effort is 
immediately successful, the diarrhoea ceases 
spontaneously. It is always best, however, to 
assist nature by the prompt administration of a 
sharp laxative. Here again castor oil is indi- 
cated on account of the after astringent effect 
produced by it. A good rule is to give a dose 
of castor oil at the beginning in every case of 
this kind; it can do no harm and will often avert 
serious illness. As is well known, diarrhceal 



THE BABY 1 49 

diseases are very common among infants, and 
very fatal, too; especially during hot weather. 
Generally, they have their origin in indigestion; 
due recognition of this fact and appropriate 
treatment at the outset would greatly diminish 
the number of fatal cases. 

Upon the appearance of looseness of the 
bowels give a dose of castor oil ; keep the child 
as quiet as possible; apply heat to the abdo- 
men, and see that it is well covered with flannel 
(wool) ; be sure that the diet is suitable, con- 
tains nothing that is hard to digest, and restrict 
it to the smallest quantity consistent with the 
maintenance of nutrition and strength. The 
quantity of fat in the food of the bottle baby 
should be reduced; and in some cases may be 
eliminated altogether — skim milk, diluted with 
water, or barley water, usually, being employed 
as the food. Avoid the mistake of attributing 
the symptoms to ''teething," and consult your 
physician without delay. 

It is a part of the routine duty of the mother, 
or nurse, to examine the dejections carefully at 
frequent intervals and note their character. The 
appearance of ''curds," or of watery or clay- 
colored discharges, indicates disorder of diges- 
tion. In the case of the bottle baby, "cheesy" 
masses, or lumps, in the discharges may be due 



150 THE BABY 

to the presence of large numbers of bacteria in 
the food (milk) ; that is, the milk in use is not 
"clean." Generally, the food or the digestion 
is at fault if the infant has more than four 
movements of the bowels in the twenty-four 
hours. Greenish stools, provided they are nor- 
mal in other respects, have no special signifi- 
cance; the discoloration, probably from the 
bile, is supposed to be due to developmental 
changes in the liver, or affecting the liver. 
These changes appear to be responsible, also, 
for mild cases of simple diarrhoea in some 
instances. 

Foul air and exposure to cold, or "draughts,'' 
are recognized as among the causes of diarrhoea. 
Continuous hot weather, particularly hot and 
"muggy" weather, predisposes to and may be 
the direct cause of diarrhoeal diseases. Pure 
air and comparative coolness are of the greatest 
assistance, and often, indeed, essential to the suc- 
cessful treatment of these conditions. In cases of 
infants suffering from these intestinal diseases, a 
change from city to seashore is usually followed 
by immediate improvement within a few hours. 

CONSTIPATION 

Constipation is often an exceedingly trouble- 
some affection. Ordinarily, the infant should 



THE BABY 151 

have at least a daily movement of the bowels; 
in some cases, however, an evacuation every 
second, or even every third day, seems to be all 
that is necessary for the maintenance of health ; 
efforts to secure a daily movement may be mis- 
placed therefore. Ordinary constipation may be 
due to a variety of causes ; among them are mus- 
cular inaction from lack of bulk in intestinal 
contents — because of the small amount of food 
taken, or of a small amount of waste material in 
the food; insufficient water; scanty secretions, 
etc. In younger infants it may be due to too 
little fat, or to too much fat in the food ; in event 
of the latter, the stools are large and grayish 
white in color. 

Constipation usually comes on gradually, and 
is likely to become more and more troublesome 
and less and less amenable to treatment; the 
earlier remedial measures are taken, therefore, 
the better. In the first place, faults in the diet, 
if any, should be corrected. Generally, more 
water should be given ; water drunk in the morn- 
ing before any food is taken is especially useful. 
Among suitable foods for the infant, after the 
first year, the following may be employed for 
their laxative effect: beef, chicken and mutton 
teas; oat jelly; baked apple and dried fruits of 
difiPerent kinds; prunes; preparations of malt, 



152 THE BABY 

which also promote digestion, and cream, which 
may always be added to the milk if necessary. 
Of these foods oat jelly and beef tea may be 
given to the youngest infants, and to infants at 
the breast. Baked apple may be given early, too. 
Frequent gentle kneading of the bowels is often 
of great assistance; this may be done several 
times a day for several minutes at a time. 

Measures of treatment that are appropriate 
in earliest infancy are referred to elsewhere. 
Most of these measures are useful generally. In 
the case of older infants rectal injections of 
water are much more effective, the rectum being 
larger; some physicians depend upon them 
almost entirely. Gluten suppositories give very 
satisfactory results in a large number of cases; 
and they may be employed continuously, if need 
be, without doing harm. The daily injection 
and retention of a small quantity of olive oil is 
often curative. 

Nothing contributes more to success in pre- 
venting and in overcoming disorder of this func- 
tion than strict regularity in its performance; as 
soon, therefore, as the child comprehends the 
uses of the commode, it should be placed on it 
at the same hours every day, to the end that a 
habit of evacuating the bowel at regular inter- 
vals may be formed. 



THE BABY 1 53 

The mother is particularly cautioned against 
the administration of cathartics in the treatment 
of constipation. Castor oil, and full doses of 
rhubarb, so useful in their places, are not only 
valueless as remedies for constipation, but they 
invariably add to the difficulty. 



'^COLD IN THE HEAD 



n 



This is a very common affection. A chronic 
^'cold" is usually dependent upon inherited 
^' blood disease." Generally, the ordinary ''head 
cold" is serious only so far as it interferes with 
nose-breathing and, therefore, with nursing in 
very young infants ; and the only treatment nec- 
essary is a mild laxative (one of the preparations 
of rhubarb is best here ; castor oil has the efifect 
to increase the secretion of mucus), a hot foot- 
bath, and inunction of the nose with vaseline. 
If, however, the inflammation is attended by 
swelling of the parts enough to prevent nasal 
breathing, the services of a physician are re- 
quired, and that without delay. Washing out 
the nostrils with a weak solution of salt in water 
affords relief, and may serve to prevent the 
swelling. 

BRONCHITIS 

Acute bronchitis may be of little importance 
in the case of the adult, but is a very dangerous 



154 THE BABY i 

disease in infancy and calls for prompt medical 
treatment. 

DISEASES OF THE MOUTH 

Inflammation of the mouth, ranging from 
"sore mouth" to ulceration, is one of the com- 
mon diseases of the ill-nourished and ill-cared- 
for from which healthy and well-kept infants 
are comparatively exempt. A sore mouth from 
mechanical irritation — as, for example, a rough- 
ened nipple — that in the case of the healthy 
infant gets well without treatment, aside from 
local cleanliness, may be the beginning of very 
serious inflammatory disease in the case of t)ie 
feeble and sickly infant in spite of treatment. 

Thrush (or sprue) is a disease of the mouth, 
usually; though it may invade the throat also, 
and sometimes extends into the oesophagus. It 
may be recognized by the appearance of slightly 
raised, grayish white patches on the inner sur- 
faces of the lips and the cheeks and on the tongue. 
These patches look very much like masses of 
curdled milk; but they are quite firmly adherent, 
while the milk curds are easily wiped ofif. 

Thrush is due to the growth of a fungus — 
one of the family of vegetable parasites of which 
mold is composed — which may be conveyed by 
anything not perfectly clean that is put into the 
mouth ; but if the mouth itself is clean, and in a 



THE BABY 1 55 

healthy condition, and the infant well nourished 
and vigorous, the parasite is not likely to effect 
permanent lodgment, and the disease will not be 
developed. 

As in the case of so many infantile ailments, 
ignorance, or carelessness, or neglect is very 
largely responsible for diseases of the mouth. 
Under all conditions, local cleanliness is the best 
preventive; it is, also, an essential part of the 
treatment always. These cases should be re- 
ferred to the physician, of course. If his serv- 
ices are not immediately available, the following 
lotion may be employed in all inflammatory con- 
ditions of the mouth, and in thrush also: 

Borate of soda 5^ drachm 
Glycerine %. ounce 

Water 4 ounces 

This mixture should be applied freely by 
means of a medicine dropper, or on a swab of 
cotton, at intervals of an hour or two. 

If the lotion cannot be obtained at once, a 
solution of cooking soda, if pure, prepared by 
dissolving a level teaspoonful of soda in a cup- 
ful of hot water, may be substituted. 

DISEASES OF THE SKIN 

Local irritation and disorders of digestion 
are prolific causes of these affections. Eczema 



156 THE BABY 

and erythema, both of which appear under 
many different forms, are oftenest encountered. 
In the youngest infants they are generally due 
to neglect, or carelessness, or ignorance on the 
part of the nurse. Ill-nourished children are 
especially subject to them, though none are ex- 
empt. Contact with acrid discharges, the fric- 
tion of coarse underclothing, the use of soaps 
of inferior quality, lack of cleanliness, on the 
one hand, and over-frequent bathing with soap, 
on the other, by which the natural fat of 
the skin is removed, are among the common 
causes of these troubles. The preventive meas- 
ures to be employed are obvious. The notion 
that harm may be done if these eruptions are 
cured — that they may be ^'driven in," whatever 
that may mean — is utter nonsense. The idea 
probably arose from the fact that the premature 
fading of the eruption in measles is often asso- 
ciated with the development of unfavorable 
symptoms; but in these cases the sudden disap- 
pearance of the rash is the effect not the cause 
of increased severity of the disease. 

As a rule, diseases of the skin are not accom- 
panied by rise of temperature; this fact and the 
absence of indications of increasing illness serve 
to distinguish them broadly from the eruptive 
fevers. Discussion of the diagnosis and treat- 



THE BABY 1 57 

ment of these diseases would be manifestly out 
of place here; it may be said, however, that 
immediately upon the appearance of an erup- 
tion, the part involved should be protected from 
irritation as far as possible; the common sources 
of irritation have been mentioned. 

RICKETS AND SCURVY 

Among infantile diseases there are twa 
which, though they cannot be reckoned as 
slight ailments, may properly be referred to 
in view of their cause and of the importance of 
their early recognition and treatment. They 
are rickets (rhachitis) and scurvy (scorbutus). 
Both are intimately associated with impaired 
nutrition. Rickets shows itself generally be- 
tween the ages of six and twenty months, though 
it may appear at any age, and maybe congenital. 
Its most marked manifestation is found in alter- 
ations of the bones, which are softened; at the 
same time, the ends of the long bones — the thigh 
bones, for example— are enlarged. A large, 
square-shaped head (skull), with high forehead 
and open spaces between the bones, is quite 
characteristic, and an open fontanelle after the 
age of eighteen months is very significant of 
rickets. Dentition is delayed. The disease is 
painless usually. Recovery is slow, but under 



158 THE BABY 

proper treatment may confidently be expected — 
usually, by the end of the third or fourth year. 

Scurvy, also, usually develops between the 
ages of six and eighteen months. For some time 
before the disease declares itself, the infant looks 
pale and suffers more or less from disorders of 
digestion. Generally, tenderness or soreness of 
the bones is the first symptom that is noticed; 
as the disease progresses, the limbs, particularly, 
become so sensitive that the child shrinks from 
the least movement. Swellings appear near the 
ends of the bones of the legs and of the arms. 
Discolorations due to hemorrhages beneath the 
skin and in the deeper parts are frequently 
observed. Bleeding from the gums and an 
ulcerative inflammation of the gums and the 
mouth are very constantly associated with the 
disease. 

Scurvy is always due to imperfect nutrition. 
It is seldom found among infants at the breast — 
never if the breast-milk is sufficient in quantity 
and normal in character. Bottle babies who 
have been deprived of fresh cows' milk are par- 
ticularly liable to it. Unless the disease is far 
advanced, rapid improvement and complete re- 
covery follow appropriate treatment, of which 
the administration of fresh fruit juices (prefer- 
ably orange juice) is an essential part. 



THE BABY 1 59 

DEFORMITIES 

Reference is made to minor deformities only 
— that may readily be prevented, or corrected, 
at the outset. The greater number of the bones 
is developed from cartilage (gristle) by the dep- 
osition of lime salts. The process by which 
the conversion of cartilage into bone is made, 
called ''ossification," is a very gradual one — so 
gradual that it is not everywhere complete until 
maturity. At birth, many bones that afterwards 
become very firmly knitted together are not 
united at all ; thus, there are wide spaces between 
certain bones of the skull, and the large opening 
— called the anterior fontanelle — toward the 
front of the middle line of the cranium does not 
close normally until about the eighteenth month. 
In infancy, and to a lesser degree in childhood, 
also, all the bones are comparatively soft, and so 
flexible that they are easily bent; accordingly, 
slight pressure, if exerted in one direction al- 
ways, may cause deformity. Curvature of the 
spine may be caused by holding the infant on 
the same side always, and "bow-legs" by pre- 
mature standing or walking. 

Such deformities ought to be prevented, of 
course; if they are allowed to occur, they may 
be corrected easily in the beginning. In the 
case of bow-legs, straightening the limbs by 



l6o THE BABY 

manipulations may be sufficient; if not, a suit- 
able mechanical device should be employed. 
But the correction of deformity never should be 
left wholly to nature. An abnormal condition 
of the bones, such, for example, as obtains in 
rickets, increases the liability to deformity. 

Unnatural protrusion of the ears is not un- 
common. In these cases the ears may be kept 
flattened against the sides of the head by the 
pressure of a cap, or other device for the pur- 
pose. If this method fails, the deformity may 
be corrected by a surgical operation. 

TONGUE-TIE 

Sometimes the fold of mucous membrane 
that passes from the under surface of the tongue, 
near its tip, to the floor of the mouth is so short, 
and the movement of the tongue so restricted in 
consequence, that the power of suction is inter- 
fered with. In these cases, the fold, called the 
''fraenum" (bridle), must be cut. This little 
operation is without risk. 

It may be remarked that tongue-tie, or other 
minor local defect, is seldom if ever responsible 
for retarded speech. Usually the infant begins 
to form words early in the second year; but, in 
the absence of brain trouble, and provided the 
hearing is good, there is no occasion for anxiety 



THE BABY l6l 

even if the power of speech is not developed in 
infancy. Indeed, a child perfectly normal in 
other respects may not be able to ''talk" before 
its third, or fourth, or even its fifth year. 

RANULA 

Occasionally a soft, fluctuating tumor, faintly 
blue in color, appears under the tongue. It is 
caused by the blocking of the duct of a small 
gland. Removal is a simple matter. 

THE HEAD 

The head of the infant immediately after 
birth is almost always more or less misshapen 
as a result of the pressure to which it has been 
subjected; the scalp often presents swellings,, 
also, which add to the distortion. But these de- 
formities are only temporary; they soon correct 
themselves, and should be left wholly to nature. 

BIRTHMARKS 

The appearances commonly known as birth- 
marks, or mother's marks, are of two kinds: 
(i) a strawberry-like tumor, slightly elevated 
above the surface of the skin; (2) a spot, or 
patch, of red or purple discoloration. Both 
consist of small blood vessels for the most part. 



1 62 THE BABY 

The first variety has a tendency to increase in 
size, and involves danger from hemorrhage, 
which is likely to be serious, and may be fatal. 
These tumors should be removed early, on this 
account. The second variety may be merely 
spots, or points of discoloration, not larger than 
a small pin-head, and they may be as large or 
larger than the palm of the hand; in either case, 
they seldom grow larger, and, unless so situated 
as to be unsightly, do not call for treatment. 

MOUTH-BREATHING 

Naturally the infant breathes, as it should, 
through the nose. Mouth-breathing invites dis- 
ease of the throat and of the respiratory track, 
and is altogether pernicious in its effects. Cleans- 
ing the nostrils should be a routine part of the 
toilet from the outset. But free passage of air 
through the nasal cavities is very often inter- 
fered with by growths of glandular tissue — 
called adenoids — in the upper part of the 
throat, behind and above the soft palate. These 
growths may be so extensive as to block the nasal 
cavities completely from behind, so that nose- 
breathing becomes impossible. They may pre- 
vent, also, the entrance of air into the small 
tubes, one on each side, that extend from the 
throat to the middle ear, thus serving as the 



THE BABY 1 63 

primary cause of the diseases of the ear to which 
impairment of the hearing is most frequently 
due. In some cases they give rise to a peculiar 
deformity of the face from protrusion and nar- 
rowing of the upper jaw. And for some un- 
known reason they sometimes interfere with the 
mental development. 

The removal of adenoids is easily accom- 
plished by an operation that is practically with- 
out danger, and from which the recovery is 
prompt and perfect. Generally, the growths 
once removed do not recur. The habit of 
mouth-breathing during sleep may be acquired, 
the nasal passages being perfectly free; and after 
the removal of nasal obstructions, the mouth 
often falls open in sleep from relaxation of the 
muscles. Special devices for holding the mouth 
closed are furnished by dealers in surgical in- 
struments. A very simple one is applied by 
passing two rather narrow strips of adhesive 
plaster diagonally across the mouth from the 
upper to the lower lip — the strips should be 
crossed in the middle line. 

Other habits, as, for example, ^^thumb-suck- 
ing," and habits of posture and movements, may 
give rise to deformities, if they are allowed to 
become fixed. In most instances the require- 
ments for a cure of the fault are plain enough; 



164 THE BABY 

but a remedy at once effective and appropriate 
is not always easily found. Each case must be 
considered by itself. 

THUMB-SUCKING 

Industrious thumb-sucking may cause pro- 
trusion of the upper teeth, or of the upper jaw, 
particularly if there are ^'adenoids." A great 
many different measures are employed in the 
effort to break up this habit, of which painting 
the thumb with a solution of some bitter drug, 
quinine, for example, is commonest; but it fre- 
quently fails. Wrapping the thumb in adhesive 
plaster — surgeon's plaster — often proves to be 
an efficient treatment. 

CARE OF THE MOUTH 

The importance of keeping the mouth of the 
young infant clean to prevent local disease from 
irritation due to the fermentation of adhering 
food, has been referred to, and the same care 
should be exercised throughout the periods of 
infancy and childhood. It often happens that 
the first teeth, or some of them, come through 
the gum before the enamel — the very hard 
substance that covers the exposed portions of the 
teeth — is fully developed; these teeth are liable 
to decay very soon after their eruption. Decay 



THE BABY 1 65 

of the teeth is caused by bacteria, for whose 
growth particles of food that find lodgment 
between them furnish a suitable soil. These 
particles should be removed by the use of a 
toothpick of soft wood and a toothbrush. 
Breaks in the enamel should be stopped at once 
by a "soft filling," which not only preserves the 
teeth, but prevents future suffering from tooth- 
ache. During the second year the infant may 
be taught to use the toothbrush for himself. 

RUPTURE (hernia) 

Rupture, or hernia, means the protrusion of 
some part of the contents of the abdominal 
cavity, usually a small portion of the intestines, 
through the abdominal walls. There are several 
weak spots in these walls and, therefore, several 
varieties of hernia. In the case of the infant, 
hernia appears oftenest at the navel (umbilical 
hernia), as a small, soft lump (tumor) that 
usually disappears under slight pressure of the 
fingers, returning as soon as the pressure is re- 
moved. Occasionally the rupture is in the 
groin. The condition is not a serious one, 
though it may become so if neglected or badly 
managed. 

As soon as a rupture is discovered, the case 
should be referred to a physician; for while 



1 66 THE BABY 

the opening in the abdominal wall may close of 
itself, there is no assurance of it; moreover, until 
the intestine is returned to its place and held 
there by a suitable support, there is risk of com- 
plications that may involve great danger to the 
child. The reduction of a rupture by force 
never should be attempted; only the gentlest 
manipulation is permissible in any case. Early 
treatment is usually very simple and promptly 
successful. In many cases of umbilical hernia, 
a strip of adhesive plaster properly applied fur- 
nishes a sufficient support. 

CIRCUMCISION 

In infancy, the foreskin is normally slightly 
adherent to the part — called the glans — which 
it covers; later, these adhesions disappear nat- 
urally, as a rule. But an extensive and close 
adherence of the foreskin may interfere with 
the escape of the urine, and give rise to local 
inflammation, or to irritation sufficient to cause 
serious disturbances of the nervous system; even 
convulsions may be due to this cause. In event 
of nervous disorders the condition of these parts 
should be inquired into always. 

The adhesions may be broken up forcibly, or 
a portion of the foreskin may be removed by cir- 
cumcision. This little operation should be done 



THE BABY 1 67 

in the interests of cleanliness when the opening 
of the foreskin is so small that the glans can- 
not be freely exposed for the removal of the 
secretions that gather behind it. In the female, 
the analogue of the penis is provided with a 
foreskin also, which, as in the male, may be so 
firmly adherent to the underlying parts that 
similar treatment is necessary, for the same 
reasons. 

HICCOUGH 

Hiccough is a spasmodic or convulsive move- 
ment of the diaphragm. The diaphragm, which 
is composed of muscle and tendon, forms the 
partition between the cavity of the chest and 
the cavity of the abdomen, and is the chief 
muscle of respiration. Spasmodic contractions 
of this muscle may be due to a great variety of 
causes. Unless it is associated with some dis- 
ease, hiccough is usually caused by indigestion. 
The occasional attack in the healthy infant may 
be cut short by giving a sip of cold water; by 
friction over the stomach; by distracting the 
attention; but the remedy sometimes employed 
— startling the child by a sudden unexpected 
movement, or noise — is "worse than the dis- 
ease." Frequent attacks of hiccough call for 
investigation as to their cause. 



1 68 THE BABY 

It should be observed that, with few excep- 
tions, every one of the disorders and diseases 
that have received special mention proceed from 
causes that may be and, therefore, ought to be 
prevented; there could be no more impressive 
witness to the need and the value of a knowledge 
of right principles of infant care and infant 
feeding on the part of those who are immedi- 
ately responsible for the health and the life that 
so often depend upon it. 

ACCIDENTS AND ''EMERGENCIES'' 

The disposition that most babies have to put 
all sorts of things into the mouth, and sometimes 
to force small bodies into the nose or into the 
ears, exposes them to peculiar dangers. The 
common practice of carrying all possible objects 
of interest to the mouth is explained, probably, 
by the fact that the sense of touch is keenest at 
the tip of the tongue. Foreign bodies put into 
the mouth are usually swallowed, if not re- 
jected; but they maybe drawn into the windpipe 
by a forcible inspiration. 

If swallowed, provided they are small enough 
to get through the gullet into the stomach, as 
they generally are, they will go the rest of the 
way without any difficulty, as the gullet is 
the narrowest portion of the alimentary canaL 



THE BABY 1 69 

If a pin, or other object that has sharp points, 
a roughened or a cutting surface, is swallowed, 
the child should be induced to take a quantity 
of absorbent cotton, well ^'picked apart," if 
possible. This may be given in milk. In any 
case, neither emetics nor laxatives should be 
given. As a rule, no harm is done if the case 
is left wholly to nature. 

If a foreign body enters the windpipe, the 
accident is a very serious one, unless it is ex- 
pelled at once by the violent coughing that 
immediately follows. The treatment must be 
prompt. Sometimes a sharp blow between the 
shoulders will dislodge the object; if this is not 
immediately successful, the child should be held 
by the feet and legs, head downwards, and gently 
swung to and fro in this position while two or 
three light blows are given with the open hand 
between the shoulders. This measure should 
not be repeated; if it does not succeed the first 
time, a surgical operation offers the only chance 
for life. 

Foreign bodies in the nose seldom give rise 
to serious trouble. Sneezing will generally dis- 
lodge them, and this may be provoked by tick- 
ling, or by putting a little snuff into the free 
nostril. 

Foreign bodies in the ear speedily excite 



170 THE BABY 

inflammation, which may be followed by serious 
and even fatal results, as it is liable to extend 
from the external canal to the ear drum and 
thence through the middle ear to the brain. 
Small bodies may be removed by freely but gently 
syringing the ear with warm water. A probe 
ought never to be used because of the danger of 
piercing the ear drum. Insects may be gotten 
out by excluding the air; for this purpose a little 
warm oil or warm water may be poured into the 
ear, or the ear may be plugged with cotton sat- 
urated with a warm solution of salt and water, 
the patient being turned on the affected side. 
After a few minutes the plug may be removed, 
generally with the insect embedded in the cotton. 
Particles of sand, or other material, may be 
removed from the eye when lodged under the 
upper lid by grasping the lid firmly, lifting it 
away from the eyeball and pulling it well down 
over the lower lid. As it slides back into place 
the ofifending substance will often be dislodged, 
when it will be found clinging to the lower 
lashes. This little maneuver may be repeated 
several times without risk of doing harm. 

FALLS 

Though the infant is particularly liable to 
slight accidents, it usually escapes serious injury 



THE BABY 171 

on account of the great elasticity of its bones. 
A fall, however, may be followed by very seri- 
ous consequences if either the brain or the spine 
is injured. In case of a severe fall it should 
not be hastily concluded that no harm has been 
done, as symptoms may not develop until some 
time afterwards ; for several days, therefore, the 
child should be kept as quiet as possible. Con- 
cussion of the brain, which may result from a 
blow on the head, is quickly followed by uncon- 
sciousness; the skin is pale and cold; the respira- 
tion sighing; the pupils contracted, or unequal; 
the pulse very rapid and feeble. Should such 
symptoms appear, the sufferer must not be dis- 
turbed, but kept in the horizontal position, with 
the head low; the clothing should be loosened 
over the chest; a hot plate put over the stomach 
and hot bottles to the extremities, which may be 
rubbed briskly at the same time to stimulate the 
circulation. Vomiting means that "reaction" is 
setting in, when effort at stimulation should 
cease; the treatment of this stage (reaction) 
must be directed by the physician. 

BRUISES 

A bruise may be treated by very hot or by 
very cold applications, and by pressure. Only 
dry heat should be applied. The pressure of a 



172 THE BABY 

coin or other hard substance has a tendency to 
prevent discoloration by distributing the effused 
blood which gives rise to it. 

WOUNDS 

Wounds, however slight, should be thoroughly 
cleansed before they are dressed, and all foreign 
material carefully removed. Mopping the part 
with tepid water promotes bleeding, which, to 
a moderate amount, is desirable for cleansing 
the wound ; it may be controlled by making firm 
and continuous pressure over the wound by 
means of a compress (a firm pad of perfectly 
clean cloth), which may be wrung out in very 
hot water or in very cold water. Hemorrhage 
from an artery is distinguished by the color of 
the blood, which is bright red (crimson), and 
by the fact that the blood spurts from the severed 
vessel with considerable force, which may be 
increased at regular intervals that correspond 
with the pulsations of the heart. This kind of 
hemorrhage may be checked by compressing the 
artery somewhere in its course between the heart 
and the wound; for example, bleeding from an 
artery in the arm may be stopped by placing a 
large book well up under the arm and keeping 
the limb firmly pressed against it; bleeding from 
the leg, or foot, by raising the limb and flexing 



THE BABY 1 73 

the knee-joint over the back of a chair so that 
pressure will be made behind the knee where the 
main artery is situated. The arteries in either 
extremity may be compressed, also, by tying a 
handkerchief around the limb above the wound, 
a compress being placed directly over the course 
of the vessel from which the blood comes, and 
twisting it tightly with a stick inserted at right 
angles. In case of bleeding from a large, gaping 
wound, picked lint, or clean rags, should be 
packed closely into the wound and firm pressure 
made over it by means of the fingers, or by a 
compress and bandage. All these measures are 
merely temporary, of course; but they are of 
universal application. 

NOSEBLEED 

Find out from which nostril the blood comes^ 
and hold the hand and arm of that side above 
the head; at the same time, pinch the nose be- 
tween the fingers and apply cold to the forehead. 
The object of these measures is the formation of 
a clot within the nostril. Immersion of the hands 
or the hands and feet in hot water is helpful. 
After the bleeding has been checked the child 
should be kept quiet that the clot may not be 
dislodged. 



174 THE BABY 

STINGS OF INSECTS 

These are best treated by cleansing the part 
and sponging it with strong water of ammonia 
or with soda water. The sting of the honey bee 
is left in the wound; it should be removed. 

CONVULSIONS AND SPASMODIC CROUP 

In view of the suddenness and severity of the 
attack in these cases, convulsions and spasmodic 
croup may be reckoned among '^ emergencies." 
The latter affection is rather a disease of early 
childhood than of infancy, occurring most fre- 
quently between the ages of two and five years. 

Premonitory symptoms of convulsions are 
drowsiness, fretfulness, disturbed sleep, moan- 
ing, movement of the jaws, and, especially, mus- 
cular twitching. The eyes often have an unnat- 
ural appearance, and at intervals the child may 
look fixedly at surrounding objects, but, appar- 
ently, without seeing them. If the seizure is 
caused by the presence of worms, or other irri- 
tant in the intestines, the abdomen is likely to be 
distended, also. Upon the appearance of this 
group of symptoms, endeavor should be made 
to secure prompt evacuation of the bowels; this 
will sometimes abort an impending attack. For 
this purpose a rectal injection of salt and warm 



THE BABY 175 

water may be given, or a full dose of castor oil, 
or both. 

Upon the occurrence of a convulsion (unless 
it happens during the progress of well-defined 
illness, when the physician will have prescribed 
the treatment; or is clearly due to brain trouble, 
when treatment, unhappily, is of no avail) the 
child should be quickly immersed in warm water 
(100° to 105°), to which a teaspoonful of mus- 
tard may be added. It should be kept in the 
bath from ten to twenty minutes, cold water 
being applied to the head meanwhile. As soon 
as the convulsive movements cease, the injection 
of salt and water should be given, unless already 
administered. Injections should be made with 
the infant lying on its left side, as this position 
has the effect to increase the capacity of the 
rectum, and the fluid is less likely to be rejected ; 
a napkin firmly pressed against the outlet for a 
few minutes will assist its retention. To clear 
the bowel, from 2 to 4 ounces of water (four to 
eight tablespoonfuls) should be used. Care 
should be taken to prevent the entrance of air 
with the water. 

In every instance, careful inquiry should be 
made as to the cause of the seizure, that it 
may be removed if possible, and further attacks 
prevented. 



176 THE BABY 

Spasmodic croup (^'false croup") is a dis- 
ease of childhood rather than of infancy. It is 
mentioned here because it is important to dis- 
tinguish it from ''true" (membranous) croup. 
False croup may be caused by intestinal irrita- 
tion, though a "cold" is oftenest associated with 
it, and it is generally preceded by a slight cough. 
In the case of vigorous children, this disease is 
never dangerous in itself, nor is it likely to be 
followed by serious results. The attack, how- 
ever, is very often alarming. Generally it comes 
on very suddenly, and almost always during the 
night, the child waking from a sound sleep with 
a hoarse, sonorous cough and husky voice, strug- 
gling for breath; the face, flushed at first by the 
violence of these efforts, soon becomes dusky, 
and the extremities cold. After a time, from one 
to three hours, the spasm relaxes and the little 
sufferer again breathes quietly, perhaps falls 
asleep ; but the attack may be repeated after a 
few hours. 

These distressing symptoms are caused by 
spasmodic contractions of the muscles of the 
throat which interfere with the free passage of 
air to the lungs, and the immediate treatment 
should be addressed to the relief of this condi- 
tion. The spasm may be relieved by an emetic 
(Syrup of Ipecac in teaspoonful doses, repeated 



THE BAB\ 177 

every twenty minutes until emesis occurs) , or by 
the warm bath given as directed under convul- 
sions ; or both may be employed. Cloths wrung 
out in cold water may be bound about the throat, 
also, for the same purpose. After-treatment is 
generally called for on account of the inflamma- 
tion usually present. In cases of children who 
are especially subject to this affection, the nose 
and throat should be thoroughly cleansed before 
they are put to bed for the night, whenever they 
have a ''cold"; attacks may sometimes be pre- 
vented by this simple proceeding. A spray of 
salt and water, or of DobelVs Solution^ may be 
used for the purpose. 

TRUE (membranous) CROUP 

This is a far more serious disease. Spas- 
modic croup comes on suddenly; true croup, 
on the contrary, develops gradually, the symp- 
toms, which may be very slight in the beginning, 
steadily increasing in severity; in this disease 
the cough is harsh rather than loud, and the 
voice, becoming weaker and weaker as the dis- 
ease advances, may be lost altogether. In true 
croup, the obstruction is caused by a membrane, 
which may be seen in the throat, or in the ma- 
terial coughed up, usually; the membrane is 
generally if not always "diphtheritic"; that is, 
the disease is diphtheria. 



178 THE BABY 

EARACHE 

Earache may often be relieved by pouring a 
little warm water into the affected ear, after- 
wards plugging it with a bit of cotton. Heat 
should then be applied by means of a salt or 
sand bag. 

REMEDIES 

A few simple remedies may be kept at hand 
with advantage: 

Castor Oil (dose one teaspoonful, or more) 
is both safe and efficient as a cathartic. Its 
astringent after-effect makes it peculiarly useful 
in the treatment of infantile disorders, as its 
purgative action involves no risk of setting up 
diarrhoea. 

The Compound Mixture of Rhubarb and 
Soda, prepared according to Squibb's formula, is 
an excellent remedy in cases of slight indigestion, 
and as a mild laxative. The dose, for infants, 
ranges from one-quarter to one teaspoonful. 
The smaller doses may be given after each feed- 
ing, or after each alternate feeding, in cases of 
^'sour stomach," flatulency, etc. As a mild laxa- 
tive, a teaspoonful may be given, and repeated 
at intervals of four hours until effective. Like 
castor oil, rhubarb, as a laxative, has an astrin- 
gent after-effect; it is useful, therefore, in the 
same conditions. 



THE BABY 1 79 

Syrup of Ipecac in teaspoonful doses is a 
reliable emetic. This dose may be repeated 
every twenty minutes until vomiting occurs. 

Anise Cordial, or the following '^baby mix- 
ture" — which, of course, contains no opium, is 
useful in cases of colic : 

Asafoetida 8 drops 

Bicarbonate of soda 8 grains 

Anise cordial 2 drachms 

Water i ounce 

These ingredients are to be mixed together. 

The dose of this mixture is from one-quarter 
to one teaspoonful in a few teaspoonfuls of hot 
water; it may be repeated several times at short 
intervals, if necessary. Hot external applica- 
tions should be used at the same time. 

Camphorated Oil, for external use, is a mild 
"counter-irritant," serving the same purpose 
that the mustard plaster serves in the case of the 
adult. 

The fact that maladies so widely different in 
their manifestations as spasmodic croup, diar- 
rhoea, and convulsions may be and are often 
directly due to intestinal irritation, the result of 
indigestion, emphasizes the importance, repeat- 
edly insisted upon, of giving the most careful 
attention to the diet throughout the periods of 



l8o THE BABY 

infancy and childhood. Not health alone, but 
the growth and development of the child de- 
pend upon its having the right kind of food, 
in suitable quantities, and at proper intervals. 
Its requirements in these respects are of para- 
mount importance; that they may be met, time 
and thought must be given to the subject and 
constant watchfulness maintained. The duty is 
arduous, but the rewards are ample. 



CHAPTER XIII 

The Care of the Mother in Pregnancy — Convalescence 

after Labor 

THE physical condition of the mother in 
pregnancy has an important influence upon 
that of her offspring at birth. In view of the 
number of weaklings that are born only to 
die after a brief, pathetic struggle, and of the 
frequency with which miscarriage occurs as 
the result of maternal causes, it behooves the 
would-be happy mother not only to observe 
strictly the ordinary laws of health throughout 
this period, but to take especial precautions in 
view of her condition. Unhappily, pregnancy 
does not confer immunity from disease, and 
extraordinary pains should be taken to avoid 
exposure thereto at this time. Any disease that 
impairs the nutrition of the mother interferes 
with the development of the child; among prev- 
alent maladies, intermittent (malarial) fever has 
a particularly pernicious influence in this re- 
spect. Certain diseases also may be transmitted 
directly from the mother to the child before its 
birth. 

The dietary during this period should be 



1 82 THE BABY 

generous. Many women in this condition have 
a craving for certain articles of food; this may 
be gratified within reasonable limits. Toward 
the end of pregnancy the number of meals a day 
may be increased with advantage, the quantity 
of food taken at a time being diminished accord- 
ingly. A daily evacuation of the bowels should 
be secured; if the use of laxatives is necessary, 
their selection ought to be left to the physician. 

Regular exercise should be taken. While 
very hard work, particularly lifting heavy 
weights, running a sewing machine, and wash- 
ing, must be avoided, the ordinary duties of the 
housewife may be done with advantage. Riding 
over rough roads, or in jolting vehicles, a long 
railroad journey, any sudden jar — a misstep, 
even — "reaching," straining at stool are among 
the indiscretions that may be followed by mis- 
carriage; during the week when, ordinarily, 
menstruation would have occurred, especial care 
is necessary to prevent this accident. Whenever, 
in the course of pregnancy, the slightest back- 
ache is felt, the expectant mother should lie down 
immediately, and if any further symptoms ap- 
pear, at once summon a physician. 

All the clothing should be worn loose, and 
suspended from the shoulders that there may be 
no compression of the breasts or of the abdomen. 



THE BABY 1 83 

During the last weeks of pregnancy, partic- 
ular attention should be given to the breasts with 
a view to the prevention of depressed and ^^sore" 
nipples. Only the gentlest manipulation is 
allowable. The nipples may be toughened by 
the use of alum and alcohol, or other astringent; 
but these applications should always be followed 
by the free use of a bland ointment (a mixture 
of lanolin and cold cream, i part to 3, has been 
recommended) ; merely tough nipples are par- 
ticularly liable to ''crack"; they should be 
pliant, also. 

Whatever tends to excite the emotions should 
be avoided. Although the popular belief as to 
the effect of vivid maternal impressions is not 
warranted, cases are not wanting to prove that 
the normal development of the child may be in- 
terfered with because of violent emotions or 
severe shock to the mother, and this possibility 
should not be overlooked. 

i 
CONVALESCENCE AFTER LABOR 

As soon as possible after the birth of the 
child, complete rest and quiet should be secured 
to the mother. Sleep, if only for an hour, or 
less, is especially desirable at this time, and to 
this end the room should always be darkened. 
The nurse, with the child, should withdraw as 



184 THE BABY 

soon as , the patient has been made comfortable, 
repci^Tning, of course, within call that she may 
respond at once if summoned. 

Especial pains must be taken to avoid mental 
excitement on the part of the mother. The child 
may be shown to her if she desires it, but it 
should not be forced upon her attention. Dur- 
ing the first week friends should be rigidly ex- 
cluded from the lying-in room; even the visits 
of the husband or nearest relatives should be 
limited in frequency, and should not be pro- 
longed beyond a few minutes. From the outset, 
any position that is comfortable may be taken 
in bed, and the position should be changed 
frequently. 

As soon as the patient is rested somewhat it 
is well to administer a cup of hot milk, or gruel. 
For a day or two, or until the bowels have 
moved and the appetite returns, a diet of milk, 
gruel, eggs, etc., is all that is required. But the 
old practice of "starving" the patient is no 
longer followed; on the contrary, she is directed 
to have a generous dietary; while for a few days 
it may be limited to the simpler articles of 
food, it should be increased gradually until at 
the end of a week it contains the variety to which 
she is accustomed. The propriety of this plan 
is obvious when we consider that not only 



THE BABY 1 85 

must the needs of her own system exhausted by 
fatigue and loss of blood be provided for, but 
nourishment must be furnished for the child, 
also. 

Assuming that precautions have been ob- 
served to prevent depressed, or "sore" nipples, 
care must be taken to keep them in good condi- 
tion; to this end they should be bathed before 
each nursing with a saturated solution of borax, 
and after each nursing thoroughly cleansed with 
water. If milk is left on them it is apt to "sour," 
and this not only invites disease of the nipples, 
but is likely to disturb the child's digestion. 
Should cracks and excoriations occur (and if 
the nipple is unduly sensitive close examination 
in a good light should be made at once, as a very 
small break in the surface is sufficient to cause 
a great deal of trouble) the nipple should be 
painted immediately with compound tincture 
of benzoin, applied with a camel-hair brush 
several times a day, and a nipple shield at once 
provided. Difficulty in getting the child to use 
this device is sometimes experienced, but it can 
be overcome by perseverance. The glass should 
be partially filled with milk expressed by the 
fingers, before the child is applied, and, while 
it is nursing, kept in close contact with the breast. 
It should be needless to say that the shield must 



1 86 THE BABY 

be kept scrupulously clean ; it is well to immerse 
the rubber nipple in a weak solution of bicar- 
bonate of soda when it is not in use. 

Throughout lactation the utmost local clean- 
liness must be observed; it is the most effectual 
preventive not only of sore nipples, but of the 
far more serious trouble commonly known as a 
^'broken breast" (abscess). An abscess may be 
caused by the thickening and subsequent fer- 
mentation of the milk in one of the lacteal ducts. 
It is announced by the appearance of a hard and 
exceedingly tender and painful lump in the 
breast. When due to this cause the threatened 
suppuration may often be prevented by thor- 
ough massage of the gland, which should be 
done at once as follows: The breast having been 
anointed with camphorated oil (this is best, 
though sweet oil or vaseline will do) , the attend- 
ant should begin by stroking it very gently from 
the line of its circumference towards the nipple, 
using the tips of the fingers only. The object 
of this is to clear the ducts of the thickened 
secretion. The entire breast should be treated 
in this way, especial attention being given to the 
painful spots. As the tenderness decreases, the 
force of the manipulation should be increased 
gradually, though it never should be sufficient 
to cause much pain. As soon as deep pressure 



THE BABY 1 87 

can be borne, or is but slightly painful, the palm 
of the hand should be firmly applied to the hard 
spot, which should be gently forced toward the 
nipple; in this way the duct may be emptied. 
Whenever the pressure becomes painful it should 
be discontinued and the stroking movements re- 
sumed, the manipulations being kept up until 
the entire organ has become soft and flaccid, 
after which a snug bandage should be applied, 
care being taken that the nipples are not com- 
pressed by it. This bandage must be adjusted 
with the utmost nicety in order that as nearly as 
possible equal compression shall be made all 
over the breast. 

Numerous special bandages have been de- 
vised, but one that may be extemporized as fol- 
lows is as good as any for the purpose : Two stout 
pieces of linen are fastened together in the form 



of a 



-B 



; the tailpiece, A, should be 

about four inches wide, and long enough to go 
a little more than half around the patient's chest. 
The crosspiece, 5, should be about twice as 
long and wide enough to extend from an inch 
below the breasts to the edge of the areola. 
To apply this bandage, draw the tailpiece, A, 
underneath the patient's back until the ends 
appear at the sides directly in the line of the 



l88 THE BABY 

nipples ; the lower end of the crosspiece is then 
drawn tightly across the chest below the edge of 
the breast and fastened, with safety pins, to the 
end of the tailpiece directly below the most de- 
pendent portion of each breast. It should be 
pinned to the binder, also, to prevent its slipping 
up. The upper end of the crosspiece is then 
carried across the chest, above the edge of the 
breasts, and fastened to the end of the tailpiece 
in the same way; it is prevented from slipping 
downward by attaching to it two pieces of cloth, 
(one opposite each breast) which are carried 
over the shoulders and secured to the tailpiece in 
the back. The entire surface of the breasts is 
then dusted with powder and a pad of absorbent 
cotton placed between them ; they are then drawn 
toward each other by the hands of the patient, 
and the bandages pinned together, beginning 
under the arms and advancing toward the nipple, 
which should be left uncovered, the compression 
being made as even as possible. The edges of 
the bandage should be pinned together between 
the breasts, also. The advantages of this ban- 
dage are that it is inexpensive, can be quickly 
made, does not compress the nipples, and per- 
mits the child to nurse while it is in place. 

Sometimes too much milk is secreted and 
sometimes too little for the needs of the infant. 



THE BABY 1 89 

The management of these conditions belongs to 
the medical attendant; it may be said, however, 
that among articles of diet, eggs, milk and oat- 
meal porridge; and among drinks, malt prepa- 
rations and chocolate are especially valuable for 
mothers whose milk supply is deficient. Pro- 
longed lactation is harmful to the mother, while 
the milk in such case is so poor in quality gener- 
ally that it does not nourish the child properly. 
Whenever, therefore, lactation becomes exhaust- 
ing, it should be wholly or partially discon- 
tinued, for the milk, even if abundant in quan- 
tity, is pretty sure to be lacking in the elements 
essential for the child's nutrition. 

Women not infrequently have trouble in 
passing urine for the first time after childbirth. 
The use of a catheter, an instrument for drawing 
off the water, should be avoided if possible, as 
it is not without risk of setting up inflammatioa 
of the bladder, and because, once the catheter is 
made use of, the patient may become dependent 
upon it; it is better, therefore, that she should 
bear considerable discomfort rather than resort 
at once to this artificial means of relief. When 
the bladder has become pretty well distended, 
she should be placed upon a bed pan, or allowed 
to turn on her face, in the hope that she will be 
able to pass the urine naturally. To this end^ 



I90 THE BABY 

also, hot cloths may be applied over the lower 
part of the abdomen and over the vulva, and 
gentle pressure employed. At the same time 
v\rater should be kept running within hearing, 
as the sound of it has an undoubted influence to 
provoke micturition. 

The discharge from the vagina that follows 
childbirth, called the "lochial discharge," is for 
the first few days red in color, from the admix- 
ture of blood, and, generally, abundant enough 
to wet the napkins or pad through three or four 
times in the twenty-four hours. (Two or three 
yards of cheese cloth — which should be washed 
— and a quantity of absorbent cotton, should be 
provided for making pads upon which to re- 
ceive this discharge.) After the fourth day, it 
is decreased in quantity, and becomes pinkish in 
color, gradually fading to a grayish white, and 
of a creamy consistency — this being its char- 
acter at about the end of the ninth day. Normal 
lochia has a disagreeable odor — quite different, 
however, from the odor of decomposition; the 
presence of the latter is an early indication 
of mischief, and as soon as detected should be 
reported to the physician. Account should 
be kept of the number of napkins soiled from 
day to day, that the physician may be able to 
judge whether the discharge is more or less than 



THE BABY 191 

normal in quantity, and direct his treatment 
accordingly. The duration of this flow varies ; 
usually it is very slight at the end of two weeks, 
but may continue quite abundant for a month, 
or more, without necessarily bad results. The 
reappearance of the sanguineous flow, however, 
is indicative of laceration, or other trouble, and 
the attention of the physician should be called 
to it at once, the patient meanwhile keeping re- 
cumbent and as quiet as possible. 

Cleanliness in the lying-in chamber should 
be insisted upon. The face and hands of the 
patient should be washed twice a day and the 
entire body bathed once a day with a sponge, 
only a part of the body being exposed at a time. 
The popular notion that combing the hair dur- 
ing the first week is likely to excite hemorrhage 
is without foundation; of course the patient is 
not permitted to dress the hair herself, or to raise 
her head from the pillow while it is done. 

Some women suffer acutely from ''after- 
pains" caused by persistence of uterine contrac- 
tion after delivery. These pains seldom occur 
at the first confinement, and are most trouble- 
some in women who have borne several chil- 
dren. They need occasion no anxiety, their local 
effect being rather salutary than otherwise, since 
the contractions tend to the expulsion of clots, 



192 THE BABY 

or Other material that may be contained in the 
uterus; they are not, however, to be regarded 
as evidence that the uterus is thus occupied. If 
they are very severe, relief may be had, pending 
the arrival of the physician, by the application 
of hot cloths over the abdomen. 

Ordinarily the patient should remain in bed 
for about two weeks. After the tenth or the 
twelfth day, she may sit up in bed, bolstered with 
pillows, for a few minutes once or twice a day; 
at the end of a fortnight, she may be transferred 
from the bed to a lounge placed alongside; but 
preferably, she should not walk at all before 
the end of the third week, though during this 
week she may sit up for a short time twice a day. 
The fourth week she can go about the room, 
and the fifth about the house. At the end of six 
weeks she will be able to resume her usual duties 
and pleasures. 

While this very gradual "getting up" is un- 
doubtedly best, reducing the risk of subsequent 
uterine trouble to a minimum, the period of con- 
valescence may be shortened somewhat after the 
second week in the cases of those who cannot 
well spare so much time from their families; 
but whenever efforts to make more rapid prog- 
ress are attended by great fatigue, by dizziness, 
backache, or other untoward symptoms, they 



THE BABY 1 93 

should be suspended immediately. In all cases 
the first ten days should be spent in bed; after 
this, the successive steps toward recovery may 
be hastened; they must, however, be taken with 
strict regard to their effects in each case. There 
are two quite constant indications for rest in bed 
which should be heeded always: (i) backache, 
(2) reappearance of blood in the discharge 
from the vagina. Many women sufifer from 
uterine disease, following, it may be, long after 
childbirth, or a miscarriage, but which, never- 
theless, is directly due to imprudence during the 
period of convalescence therefrom, particularly 
to '^getting up" too soon — before nature has 
had time to complete her perfect work of 
restoration. 



4 



INDEX 



Abdominal band, 6, lo, 103, 
114 

organs, 2 
Accidents, 168 
bleeding, 172 
bruises, 171 
falls, 170 

foreign bodies, in ears, 169 
in eyes, 170 
in nose, 169 
in windpipe, 169 
swallowed, 169 
wounds, 172 
Adenoids, 12, 162 
Air, foul, I 29, 1 50 
Anise cordial, 179 
Artificial feeding, 1 3 

foods, 83-88 
Attendant, 127 

Baby, new-born, 4—12 
Bacteria, 35, 37—40, 50, 60, 

61, 150, 165 
Barley jelly, 96, 99 

water, 45, 72, 78 
Bath, effects of cold, 119 

effects of hot, 123 

sponge, 10, 120 

temperature of, 1 20 

tub-bath, 121 

use of soap, 120, 122 
Bathing, 1 19— 123 

new-born baby, 5, 10 
Bed hour, 1 1 1 , 113 



Birthmarks, 161 

** Blue-babies," 145 

Bottles, milk, 38, 51, 55" 

nursing, 52, 59, 93 

washing, 94 
** Bottle- wind," 89 
Bowels, first discharge from, 7 

first discharge delayed, 8 
Bow-legs, 10, 159 
Breast-milk, analysis of, 29 

earliest secretion of, 7 

effects of excitement on, 22 

modified by diet, etc., 24 

unfitness as food, 107, 189 
Breast pump, 26 
Breasts, inflammation of, 144 

massage of (see lactation) 
Breathing, abdominal, 115 

hindrances to nasal, 9, II, 12 

mouth, 162 

Casein, 30 

digestion of, 64 
Castor oil, 140, 148, 175, 178 
Cathartics, 153 
Catnip tea, 8 
Cereal waters, 45 
Circumcision, 166 
Clothing, 1 1 4- 1 1 6 
** Colds in the head," 12, 153 
Colic, 'jd, 146 

massage in, 147 
Commode, 128, 152 
Condensed milk, 86 



195 



196 



THE BABY 



Constipation, 60, 139, 

1 50-1 52 
Contagious diseases, exposure 

to, 128 
Convalescence, after child-birth, 

183-193 
Convulsions, 174 
Cotton wool, 54 
Cord (navel), 144 

Dressing of, 6 
Covins, breeds of, 36 
Cows* milk (see milk) 
Cream, centrifugal, 33 

gravity, 33 

varieties of, 34 
Cream dipper, 55 

Croup, 135, 174 
Crying, 135, 136 
Cry, in brain disease, 135 

in sleep, i 38 
Curvature of spine, 159 

Deformities, 159-160 
Dejections, abnormal, 140, 149 

earliest, 7 

in fat-indigestion, 76 

in over-feeding, 72 

normal, 7, 75 

number in 24 hours, 1 40 
Dentition, 124-126 

delayed, 157 
Diapers, 6 

rubber, 10 
Diarrhoea, 74 

castor oil in, 149 

diet in, 148 

from indigestion, 148—150 

simple, 140 
Diet of nursing mother, 23 



Digestion, 18—22 

deficiencies of, 3 

of fat and proteins, 31 
Digestive fluids, 18 
Diluents, 32 

cereal waters, 45 

plain water, 46 

whey as, 62 
Disease in infants, 132—135 
Diseases of youngest infants, 

I35-H5 
of older infants, 1 46- 1 5 8 
Dust, 1 1 8 

Ear, ache, 135, 178 

inflammation of, 116 
Ears, protrusion of, 160 
Emergencies, 168 
Emetic, 179 
Eruptions, 72, 156 
Evaporated cream, 86 
Exercise, 117, 118 

for mother, 23, 24 
Eyes, care of, 4 

inflammation of, 142 

lotion for, 142 

squinting, i 34 

staring, 174 

Falls, 170 

Farinaceous foods, 85 
Fat, of cow's milk, 30, 31 

deficiency of, 77 

digestion of, 19, 21 

emulsion, 33, 34 

excess of, 76 

fatty acids, 30 

indigestion, 76 

nutritive ofiice of, 16, 65, 73 



THE BABY 



197 



Fat, sources of, 1 5 
Fat baby, 87, 134 
Feeding, directions for, 88—95 

day, 91 

in weak fat-digestion, 78, 

.79 

in weak protein-digestion, 78 

new-born baby, 8 

night, 92, 1 1 1 

premature infant, 108, 109 

regularity of, 102 
Feet, 1 1 6 
Fever, 133 
Flat-foot, 128 
Fontanelles, 11, 159 

open, 157 
Food, breast-milk, 22 

condensed milk, 86 

cows' milk, 29 

elements of, 13—16 

farinaceous, 85 

patent foods, 84—88 

sources of, 83—84 

substitute, 28 

suitable, 75, 151 

unsuitable, 102 
Fretfiilness, 91, 113, 136-138, 

174 
Fruit, baked, loi, 102 

baked apple, 152 

in scurvy, 158 

Gastric juice, 18, 19, 21, 64 
Gluten, I 5 

suppositories, i 5 2 
Gums, bleeding from, 158 

lancing, 125 

Habits, 91, 128, 130 



Head, 135, 157, 161 

scalp, 144 
Healthy infant, i 3 3 
Hernia, 127, 145, 165 
Hiccough, 167 
Humidity, 123 
Hunger, 66, 137 

in premature infant, 108 

Incubators, 106 
Indigestion, 76—79 

of fat, 76 

intestinal, 78 

protein, 76 

sugar, 76 
Infancy, period of, i 
Inflammation of breasts, 144 

eyes, 5, 142 

mouth, 154 

pain of, 148 

skin, 143 
Insects, in ear, 170 

stings of, 174 

Jaundice, i 3 8 
Jelly, barley, 96, 99 
oat, 96, 99 

Lactation, 22—27 

delayed, 8 

hindrances to, 24, 25 

prolonged, 189 
Lead poisoning, 94 
Lime, 32 

water, 44, 59 

Massage, abdomen, 147 
breast, 26, 27, 186, 187 



198 



THE BABY 



Mental excitement, effects of 
in mother, 22, 183 

in infant, 103 
Milk (cow's), analysis of, 29 

"baby milk," 41 

boiled, 61 

care of, 40, 55 

clean, 38 

dirty, 61 

"fat-free,** 35 

freezing, eifect of, 55 

fresh, 39-41, 158 

laboratory, 48 

modified, 32 

preparation of, 55—57 

modifying materials, 33 

** one cow's," 81 

pasteurized, defined, 60 
food value of, 58 

"poor," 50, 51 

skim milk, 35, 41, 79 

sterilized, defined, 38 
food value of, 58, 60 

suitable, 36 

unsuitable, 36, 37, 38, 61, 76 
Minerals, 15 
Mixed feeding, 95 
Moaning, 174 
Modification of milk, 32, 47 

equipment for home, 52 
Mortality, infant, 3 
Mouth, breathing, 162 

care of, 164 

diseases of, 154, 155 

lotion for inflammation of, 

155 
Myoscin, 1 5 

Naps, 92, 103, III 



Navel, 6, 144 
Nervous shock, 103, 112 
New-born baby, 4 
Night drawers, 116 
Night nursing, 23 
Nipple shield, 26, 185 
Nipples, artificial, 9 

care of, 94 

depressed, 24, 183 

lotion for, 25 

manipulation of, 9, 24 

ointment for, 25, 183 

sore, 24, 183, 185 

tenderness of, 25 
Nose, foreign bodies in, 169 
Nosebleed, 173 
Nostrils, cleansing, 6, 121 
Nurse, 4, 126 
Nursery, 129 

Nursing bottles, 52, 59, 93 
Nursing mother, diet of, 23 
Nursling, position of, 9 
Nutritive office of food elements, 

65* 73 

Obedience, 130 
Ointment, 5, 25, 1S3 
Olive oil, 139, 152 
Opium, 1 1 3 
Out-of-doors, time, 118 
Over-feeding, risks of, 71, 103 
Over-frequent feeding, 91, 137 

Pain, abdominal, signs of, 134 
in head, signs of, 134 

Pancreas, 2 1 

Pancreatic juice, 18, 19 

Pasteurization, 58 
equipment for, 53 



THE BABY 



199 



Peevishness, 134 
Pepsin, essence of» 63 
Peptogenic powder, 78 
Percentage mixtures, 49 

modification, 49 
Peristaltic movements, 2 1 
Perspiration, 122 
Petticoats, 10 
Pinning-blanket, 6, 7 
Position of baby, in carriage, 
118 

change of, 113 

after feeding, 90 

vv^hile feeding, 89 
Pow^ders, 121 
Precocity, 131 
Predigestion, 78 
Pregnancy, 1 81-183 
Premature infant, 105-109 
Proteins, 15, 16, 24, 66, 'jd, 

77 
Prunes, 102 

Pulse, 132 

Pus in the eyes, 143 

Quantity of food, 70 

Race suicide, 3 

Ranula, 161 

Rectal injections, 139, 152, 174 

Regurgitation, 89, 140 

Remedies, 178-180 

Rennet, 41, 63 

Respiration, 132 

Restlessness, 134 

Rhubarb, compound mixture 

of, 178 
Rice, 1 01 
cones, 1 01 



Rickets, II, 77, 88, 135, 160 
Rocking to sleep, 1 1 2 
Rubber diapers, 10 
Rupture (see hernia) 

Saccharin, 72 
Saliva, 18 
Salivary glands, 2 1 
Scurvy, 40, 58, 88, 138, 

158 
Sebaceous glands, 144 
Second year, 99-104 
Sedatives, 1 1 3 
Seven months' babies, 107 
Shirts, 9, 10 
Shock, 103, 1 12 
Shoes, 128 
Shot, 94 

Silk underw^ear, 10, 114 
Skin, 122 

diseases of, 155—157 
Sleep, 23, 92, 110-113 
Sleeping room, 1 29 
Sleeves, long, 10 
Soothing syrups, 1 1 3 
Spasmodic croup, 176 
Speech delayed, 160 
Sponges, 120 
Sprue, 154 
Squinting, 134 
Standing, 119, 127 
Starch, 15, 21, 10 1 
Sterilization of milk, 57—61 
Stings of insects, 174 
Stockings, 1 1 6 
Stomach, action, 21, 64 

capacity in infancy, 63 

digestion, 19, 91 
Stools, 31, 149, 151 



200 



THE BABY 



Substitute foods, 28—99 
preparation of, 54—57 

Sugar, 15 

indigestion, 76 

Suitable food, 75 
milk, 36 

Suppositories, 152 

Swallowed objects, 168 

Tables, uses of, 67 

I. Chemical analyses of milks, 
29 

II. Feeding of the normal 
infant, 80 

III. Whey-cream mixtures, 
81 

IV. For infants whose fat- 
digestion is weak, 82 

V. For premature infants, 109 
Teeth, 124, 164 

Teething, 100, 124—126 

diarrhoea, 125 

ring, 126 
Temperature, of artificial food, 

89 

of bath, 120 

for pasteurization, 60 

for sterilization, 58, 60 

Thirst, 92, 137 

Thoracic duct, 20 

Thorax, 20 

Thrush, 154 

Thumb-sucking, 164 



Tongue-tie, 160 
Toothbrush, 165 
Travel, 128 

Underclothing, all wool, 10, 
114 
silk, 114 

Vaccination, 1 29 
Vomiting, 74, 171 

Walking, 119, 127 
Wardrobe of infant, 10 
Water, 15, 23, 46, 92, 151 

on brain, 135 
Weaning, 96—98 
Weight, average normal, 75 

guide to amount of food, 70 

index of nutrition, 75, 92 

loss of, 93 

record of, 93 
Wet nurse, 95 
Whey, 30, 41-43 
Whey-cream mixtures, 43, 

61-63, -]-] 
Whey-proteins, 30, 42 
Whole milk, 35 

Windpipe, foreign bodies in, 1 69 
Winds, exposure to, 118 
Wool underwear, 10, 114 
Worms, 174 
Wounds, 172 



SEP 29 1913 



